Evidence map›Paper›PMID 38198772›Full record

ArticleCerebrovascular diseases (Basel, Switzerland)2024

Time for "Code ICH"? Workflow Metrics of Hyperacute Treatments and Outcome in Patients with Intracerebral Haemorrhage.

Eva Bettschen, Bernhard M Siepen, Martina B Goeldlin, Madlaine Mueller, Philipp Buecke, Ulrike Prange, Thomas R Meinel, Boudewijn R H Drop, David Bervini, Tomas Dobrocky and 9 more

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In one paragraph

Article in Cerebrovascular diseases (Basel, Switzerland), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Eva BettschenDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Bernhard M SiepenDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Martina B GoeldlinDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Madlaine MuellerDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Philipp BueckeDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Ulrike PrangeDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Thomas R MeinelDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Boudewijn R H DropDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
David BerviniDepartment of Neurosurgery, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Tomas DobrockyInstitute of Neuroradiology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Johannes KaesmacherGraduate School for Health Sciences, University of Bern, Bern, Switzerland.
Aristomenis K ExadaktylosEmergency Department, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland.
Thomas C SauterEmergency Department, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland.
Bastian VolbersDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Marcel ArnoldDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Simon JungDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Urs FischerDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
Werner Z'GraggenDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.
David SeiffgeDepartment of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionKnowledge about uptake and workflow metrics of hyperacute treatments in patients with non-traumatic intracerebral haemorrhage (ICH) in the emergency department is scarce.

methodsSingle-centre retrospective study of consecutive patients with ICH between 01/2018-08/2020. We assessed uptake and workflow metrics of acute therapies overall and according to referral mode (stroke code, transfer from other hospital, or other).

resultsWe enrolled 332 patients (age 73 years, IQR: 63-81 and GCS 14 points, IQR: 11-15, onset-to-admission time 284 min, IQR: 111-708 min), of whom 101 patients (35%) had lobar haematoma. Mode of referral was stroke code in 129 patients (38%), transfer from other hospital in 143 patients (43%), and arrival by other means in 60 patients (18%). Overall, 143 of 216 (66%) patients with systolic blood pressure >150 mm Hg received IV-antihypertensive treatment, and 67 of 76 (88%) on therapeutic oral anticoagulation received prothrombin complex concentrate treatment (PCC). Forty-six patients (14%) received any neurosurgical intervention within 3 h of admission. Median treatment times from admission to first IV-antihypertensive treatment were 38 min (IQR: 18-72 min) and 59 min (IQR: 37-111 min) for PCC, with significant differences according to mode of referral (p < 0.001) but not early arrival (≤6 h of onset, p = 0.92). The median time in the emergency department was 139 min (IQR: 85-220 min), and among patients with elevated blood pressure, only 44% achieved a successful control (<140 mm Hg) during ED stay. In multivariate analysis, code ICH concordant treatment was associated with significantly lower odds for in-hospital mortality (aOR 0.30, 95% CI: 0.12-0.73, p = 0.008) and non-significant trends towards better functional outcome measured using the modified Rankin scale score at 3 months (aOR for ordinal shift 0.54, 95% CI: 0.26-1.12, p = 0.097).

conclusionUptake of hyperacute therapies for ICH treatment in the ED is heterogeneous. Treatment delays are short, but not all patients achieve treatment targets during ED stay. Code ICH-concordant treatment may improve clinical outcomes. Further improvements seem achievable by advocating for a "code ICH" to streamline acute treatments.

Indexed as

Cerebral HemorrhageTime-to-TreatmentWorkflowAgedAged, 80 and overAnticoagulantsAntihypertensive AgentsEmergency Service, HospitalFemaleHumansMaleMiddle AgedNeurosurgical ProceduresPatient AdmissionPatient TransferRetrospective StudiesAnticoagulantsAntihypertensive AgentsAnticoagulationBlood pressureIntracerebral haemorrhageReversalTreatment

Identifiers

PMID38198772
PMCPMC11633875

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.