Prehospital neurologic deterioration in patients with intracerebral hemorrhage.
OBJECTIVE
Early neurologic deterioration has been studied in patients with intracerebral hemorrhage during hospitalization, but rates and factors associated with prehospital neurologic deterioration (PND) are unknown. We sought to determine the prevalence of PND among patients with intracerebral hemorrhage during Emergency Medical Services transportation to the hospital.


METHODS
Historical cohort study.


METHODS
U.S. acute care hospital from 2000 to 2004.


METHODS
Hospitalized patients with a diagnosis of spontaneous intracerebral hemorrhage were identified by codes of the International Statistical Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).


METHODS
The initial Glasgow Coma Scale score ascertained at the scene by the Emergency Medical Services was compared with the subsequent evaluation in the emergency department to identify neurologic deterioration (defined as a decrease in Glasgow Coma Scale of > or = 2 points).


METHODS
None.


RESULTS
Of the 98 patients with acute intracerebral hemorrhage, 22 patients (22%) showed PND during Emergency Medical Services transport, with a mean decrease in the Glasgow Coma Scale score during transport of 6 points. The patients who demonstrated neurologic deterioration tended to have higher diastolic blood pressure at the scene (p = .045), greater rates of intraventricular extension (p < .0001), and radiologic signs of herniation (p < .0001) on initial computed tomographic scan. There was a statistically significant decrease in diastolic blood pressure between the evaluations of the Emergency Medical Services and the emergency department among both patients with and without PND.


CONCLUSIONS
PND occurs in nearly one fifth of patients with intracerebral hemorrhage. Higher diastolic blood pressure at the scene, intraventricular extension, and radiologically evident herniation seem to be associated with PND. Prospective studies are needed to evaluate the efficacy of Emergency Medical Services interventions to reduce this early clinical deterioration.
Moon
Joon-Shik
JS
Zeenat Qureshi Stroke Research Center, Epidemiology and Outcomes Division, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
Janjua
Nazli
N
Ahmed
Shafiuddin
S
Kirmani
Jawad F
JF
Harris-Lane
Pansy
P
Jacob
Molly
M
Ezzeddine
Mustapha A
MA
Qureshi
Adnan I
AI
D017677:Age Distribution; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D009515:New Jersey / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D016019:Survival Analysis