Outcomes of Delayed Presentation in Patients With Intracerebral Hemorrhage

The following article is part of coverage from the American Academy of Neurology’s Annual Meeting (AAN 2020). Due to the global COVID-19 pandemic, the Academy made the necessary decision to cancel the meeting originally scheduled for April 25–May 1, 2020, in Toronto. While live events will not proceed as planned, readers can click here catch up on the latest research intended to be presented at the meeting.

Prolonged delays from intracerebral hemorrhage (ICH) symptom onset to hospital presentation is associated with worse functional outcomes at 3 months, compared with earlier presentation, according to study results intended to be presented at the annual meeting of the American Academy of Neurology (AAN 2020).

While previous studies have shown that delayed hospital presentation in patients who have had an ischemic stroke is associated with worse outcomes, limited data are available on the prognostic effect of delayed presentation in patients with ICH.  The goal of the study was to explore factors associated with prolonged delayed hospital presentation in patients with ICH and the effect on long-term outcomes.

The cohort study used data from consecutive patients with ICH over 12 months. Prolonged delay in hospital presentation was defined as time to arrival >24 hours. Modified Rankin Scale (mRS) score was used to assess outcomes at 3 months, and unfavorable outcomes were defined as mRS 4-6, following adjustment for demographics and ICH severity.

The study included data from 299 patients diagnosed with ICH, including 62 patients (21%) with delayed hospital presentation. The median time to arrival was 5.5 hours (interquartile range, 1.2-17.8 hours).

Patients with prolonged delays in hospital presentation were less likely to have initial Glasgow Coma Scale score <13 (16% vs 34%; P=.02) and had lower ICH scores (median 1 [0-2] vs 1 [1-2]; P=.02) compared with patients presenting <24 hours from symptom onset. There were no differences in age, sex, race, or ICH size between the groups.

At 3 months after ICH, mRS scores were lower among patients with prolonged delays to presentation compared with those who presented within the first 24 hours of symptom onset (median 3 [1.5-4] vs 4 [3-6], P=.002), and lower odds of unfavorable 3-month outcome (adjusted odds ratio, 0.46; 95% CI, 0.22-0.97).

“Outcomes in ICH patients with prolonged delays to presentation differ from those who present earlier. ICH severity in such patients may not be accurately captured by established predictors, and prognostication models should therefore account for inherent survivorship bias,” concludes the researchers.

Reference

Reznik M, Moody S, Grory BM, et al. Long-term outcomes in patients with intracerebral hemorrhage and delayed hospital presentation. Intended to be presented at the 2020 annual meeting of the American Academy of Neurology.

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