To evaluate patient-level factors independently associated with shorter Onset-to-CT (OCT) times among patients with Intracerebral Hemorrhage (ICH).
ICH is one of the deadliest stroke types. Current guidelines on acute ICH management rely on ischemic stroke literature to determine factors associated with delayed presentation in ICH. Earlier imaging is critical to diagnosis and treatment.
Data from patients enrolled in ERICH, one of the largest multicenter, prospective, case-controlled observational ICH studies, were evaluated. Patients with missing/inaccurate onset and initial CT times, missing/in-hospital onset location, OCT >24 hours, GCS 3, and pre-morbid mRS >3 were excluded. Patients were categorized as having received CT within 1 hour vs greater than 1 hour after onset. Pearson X2 and Mann-Whitney U tests were performed for categorical and continuous variables, respectively. A binary logistic regression was performed to evaluate factors associated with receiving CT within 1 hour. Adjusted odds ratios with 95% confidence intervals are reported. All p-values were 2-sided, and significance was defined as a p-value <0.05.
Across the two epochs (n=978), median age was 60 (IQR: 51-72), 39.5% were female, and median OCT time was 2 hours (IQR: 1-3). 38.4% (n=376) received CT within 1 hour of LKW vs 61.6% (n=602) who received CT after 1 hour. After adjusting for age, ethnicity, stroke severity, bleed location, systolic BP, EMS arrival, and location of onset, the factors associated with decreased OCT time were arrival by EMS (OR, 3.24, 95% CI, 2.18-4.80), identifying as Hispanic (OR, 1.56, 95% CI, 1.17-2.08), non-lobar bleeds (OR, 1.51, 95% CI,1.07-2.13). Patients with decreased severity (higher GCS), were more likely to have prolonged OCT times (OR, 0.94, 95% CI, 0.90-0.99).
These findings suggest considerable potential for addressing patient-level factors that lead to delayed diagnosis and treatment for ICH.