2025 American Academy of Neurology Abstract Website

Objective:

To identify patient-related, provider-related, and clinical factors that delay the timely diagnosis and treatment of ICH.

Background:

Many intracerebral hemorrhage (ICH) patients fail to meet Get With the Guidelines (GWTG) and American Heart Association (AHA) diagnostic and therapeutic time targets.

Design/Methods:

We conducted a retrospective study of consecutive non-traumatic ICH patients admitted at three comprehensive stroke centers between 4/1/2023-6/30/2024. Inclusion criteria were direct admission through the emergency department (ED), stroke code activation, and requirement of antihypertensive treatment due to systolic blood pressure (SBP) >150 mmHg and/or anticoagulant use requiring reversal. Transfers, inpatient strokes, and those with last known normal (LKN)-to-door >24 hours were excluded. Demographic factors, team structure, clinical presentation, and ED complications were evaluated as predictors of meeting GWTG/AHA time targets including door-to-CT scan ≤25 minutes, door-to-BP-medication ≤60 minutes, and door-to-anticoagulant-reversal ≤90 minutes using stepwise backward multivariate regression analysis.

Results:

We identified 130 patients (median age 69 [IQR 53-77], 45% female, 45% white, 29% non-English speaking). Median LKN-to-door time was 148 (IQR 65-442) minutes. Door-to-CT ≤25 minutes occurred in 75.4%, door-to-BP-medication ≤60 minutes in 63.9%, door-to-anticoagulant-reversal ≤90 minutes in 63.6%. Significant univariate predictors of delayed door-to-CT were: non-white race (OR 4.032, 95%CI 1.597-10.204), non-English speaking (OR 3.455, 95%CI 1.492-8.001), ED walk-in (OR 6.200, 2.208-17.407), non-focal neurological deficit (OR 3.531, 95%CI 1.335-9.341), and intubation (OR 4.882, 95%CI 2.014-11.838). Fewer women met door-to-BP-medication goals (OR 2.603, 95%CI 1.111-6.099) and fewer non-English-speaking patients met door-to-anticoagulant-reversal (OR 13.000, 95%CI 1.109-152.351) (all P<0.05). Multivariate analysis demonstrated increased door-to-CT-times in non-white patients (OR 5.154, 95%CI 1.324-20.000, P=0.018), walk-ins (OR 3.841, 95%CI 1.232-11.972, P=0.020), patients with lower NIHSS (OR 1.085, 95%CI 1.004-1.174, P=0.039), and intubations (OR 11.617, 95%CI 2.437-55.375, P=0.002). No significant multivariate delay factor was found for door-to-treatment-times.

Conclusions:

Non-white patients, walk-ins, those with lower NIHSS, and those requiring intubation were more likely to experience delays in ICH care.