World neurosurgery · 2025
Neuroemergencies Management and Transfers System: Safety and Efficacy in Intracerebral Hemorrhage Patient Transfer During COVID-19 Pandemic.
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Ezzat Bahie, Afreen Ryan, Kalagara Roshini, Melo Leslie, Morozov Masha, Bose Javin, Poyraz Fernanda Carvalho, Mocco J, Bederson Joshua B, Kellner Christopher P, Dangayach Neha S, Mount Sinai NEMAT Research Group
Аннотация
OBJECTIVE: Intracerebral hemorrhage (ICH) carries significant morbidity and mortality. Efficient, resilient triage and transfer systems are critical, especially during global crises such as the COVID-19 pandemic. This study evaluates the Neuroemergencies Management and Transfers (NEMAT) program's safety and effectiveness for ICH patients requiring interhospital transfers (IHT), comparing immediate and long-term outcomes, symptomatic postoperative rebleed, home discharge, 30-day mortality, and 6-month modified Rankin Scale (mRS) scores between NEMAT and direct emergency department (ED) admissions.
METHODS: We analyzed a prospectively collected registry of ICH patients who underwent minimally invasive endoscopic evacuation at a large urban hospital (03/2017-04/2023). The cohort was categorized into 2 groups: direct ED admissions and NEMAT transfers, evaluated across 3 pandemic phases: pre-pandemic, first year, and second year. Statistical analyses utilized included univariate analyses and binary logistic regression validated through propensity score matching.
RESULTS: Among 261 patients, 221 (85%) were NEMAT transfers; median age was 63 years (IQR: 54-74). Average transfer distance was 16.8 ± 56.6 km, duration was 1.6 ± 0.6 hours. Average times from symptom onset to leaving the referring hospital (bleed-to-door out time) were 32.8 ± 21.0 hours, and from arrival at first ED to departure from first ED (door-in-door-out time) were 4.9 ± 2.2 hours. The average time taken for the patient to leave the transferring facility (transfer out time) was 2.4 ± 1.4 hours. Binary logistic regression analyses found no significant impact of IHT via NEMAT on symptomatic postoperative rebleed (OR = 1.00; 95% CI: [0.99-1.01]; P = 0.99), home discharge disposition (OR = 0.92; 95% CI: [0.33-2.54]; P = 0.87), 30-day mortality (OR = 2.08; 95% CI: [0.26-16.8]; P = 0.49), or 6-month mRS (OR = 0.99; 95% CI: [0.34-2.86]; P = 0.98).
CONCLUSIONS: This study supports the safety and viability of the NEMAT program for ICH management despite complexities introduced by the COVID-19 pandemic.
METHODS: We analyzed a prospectively collected registry of ICH patients who underwent minimally invasive endoscopic evacuation at a large urban hospital (03/2017-04/2023). The cohort was categorized into 2 groups: direct ED admissions and NEMAT transfers, evaluated across 3 pandemic phases: pre-pandemic, first year, and second year. Statistical analyses utilized included univariate analyses and binary logistic regression validated through propensity score matching.
RESULTS: Among 261 patients, 221 (85%) were NEMAT transfers; median age was 63 years (IQR: 54-74). Average transfer distance was 16.8 ± 56.6 km, duration was 1.6 ± 0.6 hours. Average times from symptom onset to leaving the referring hospital (bleed-to-door out time) were 32.8 ± 21.0 hours, and from arrival at first ED to departure from first ED (door-in-door-out time) were 4.9 ± 2.2 hours. The average time taken for the patient to leave the transferring facility (transfer out time) was 2.4 ± 1.4 hours. Binary logistic regression analyses found no significant impact of IHT via NEMAT on symptomatic postoperative rebleed (OR = 1.00; 95% CI: [0.99-1.01]; P = 0.99), home discharge disposition (OR = 0.92; 95% CI: [0.33-2.54]; P = 0.87), 30-day mortality (OR = 2.08; 95% CI: [0.26-16.8]; P = 0.49), or 6-month mRS (OR = 0.99; 95% CI: [0.34-2.86]; P = 0.98).
CONCLUSIONS: This study supports the safety and viability of the NEMAT program for ICH management despite complexities introduced by the COVID-19 pandemic.