Internal medicine journal · 2026
Optimising hyperacute intracerebral haemorrhage management: factors influencing timely intervention.
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Proper Edmund, Phan Thanh, Ma Henry, Valente Michael
Аннотация
BACKGROUND: Bundled-care protocols, which include rapid lowering of blood pressure, have improved functional outcomes in patients with intracranial haemorrhage (ICH). Specifically, the intensive blood pressure reduction in acute cerebral hemmorhage trail (INTERACT) 3 trial aimed to achieve rapid lowering of systolic blood pressure (SBP) to 140 mmHg within an hour of arrival. We analyse factors that influenced the timely delivery of hyperacute ICH management.
AIM: We aimed to identify the factors that delay the timely delivery of antihypertensive therapies for hyperacute ICH.
METHODS: A retrospective analysis of acute ICH patients admitted to Monash Health (January-December 2023) was performed to evaluate time to achieve SBP <140 mmHg. A Gamma regression model was used to assess the relationship of predictors, which included patient factors (age, GCS, admission SBP), process factors (times to antihypertensive medication, emergency department (ED) bed, computed tomography (CT) scan), and system factors (Code Stroke status, ED resuscitation bed assignment, care goals). Median times for antihypertensive medication delivery, neurosurgical review, neurosurgical intervention and anticoagulation reversal were calculated.
RESULTS: Of 209 patients (median age 74 (IQR 63-84), GCS 14 (IQR 6-15), National Institute of Health Stroke Severity 13 (interquartile range (IQR) 4-27), admission SBP 160 mmHg (IQR 137.5-187)), 52% were treated as a Code Stroke. Median time to CT was 33 min (IQR 23-47.5) with Code Stroke versus 121 min (IQR 36-254) without. Patients who received non-palliative therapies (74%) achieved SBP < 140 in 193 min (IQR 91-552) and 25% achieved this in 60 min. Higher admission SBP, longer times to ED bed and absence of Code Stroke were associated with increased time to reach 140 mmHg SBP (P < 0.01). Other dependent variables did not reach significance.
CONCLUSION: SBP on arrival, delayed access to ED beds and Code Stroke activation were key factors associated with achieving early BP lowering. These findings underscore the need for protocolised, rapid-response systems to optimise ICH management.
AIM: We aimed to identify the factors that delay the timely delivery of antihypertensive therapies for hyperacute ICH.
METHODS: A retrospective analysis of acute ICH patients admitted to Monash Health (January-December 2023) was performed to evaluate time to achieve SBP <140 mmHg. A Gamma regression model was used to assess the relationship of predictors, which included patient factors (age, GCS, admission SBP), process factors (times to antihypertensive medication, emergency department (ED) bed, computed tomography (CT) scan), and system factors (Code Stroke status, ED resuscitation bed assignment, care goals). Median times for antihypertensive medication delivery, neurosurgical review, neurosurgical intervention and anticoagulation reversal were calculated.
RESULTS: Of 209 patients (median age 74 (IQR 63-84), GCS 14 (IQR 6-15), National Institute of Health Stroke Severity 13 (interquartile range (IQR) 4-27), admission SBP 160 mmHg (IQR 137.5-187)), 52% were treated as a Code Stroke. Median time to CT was 33 min (IQR 23-47.5) with Code Stroke versus 121 min (IQR 36-254) without. Patients who received non-palliative therapies (74%) achieved SBP < 140 in 193 min (IQR 91-552) and 25% achieved this in 60 min. Higher admission SBP, longer times to ED bed and absence of Code Stroke were associated with increased time to reach 140 mmHg SBP (P < 0.01). Other dependent variables did not reach significance.
CONCLUSION: SBP on arrival, delayed access to ED beds and Code Stroke activation were key factors associated with achieving early BP lowering. These findings underscore the need for protocolised, rapid-response systems to optimise ICH management.