Clinical features associated with early hospital arrival after acute intracerebral hemorrhage: challenges for new trials.
BACKGROUND
Early hospital admission followed by correct diagnosis with minimum delay is a prerequisite for successful new interventions in acute intracerebral hemorrhage (ICH). The aim of this study was to evaluate clinical features associated with early hospital arrival in ICH patients and their influence on the outcome.


METHODS
Data from all patients arriving within 24 h of the ICH onset were prospectively collected at 2 stroke centers in São Paulo, Brazil. The cutoff of 3 h was chosen to select 2 groups: 0-3 h (early) and >3-24 h (late).


RESULTS
We identified 91 ICH patients (mean age 57.9 years, 62% men, 63% white) admitted within the first 24 h of symptom onset between March 2004 and April 2005. Systolic blood pressure, mean arterial pressure and pulse pressure were significantly higher in patients arriving within 3 h. Patients that arrived early also had a higher NIHSS score (p = 0.003), a lower Glasgow Coma Score (p = 0.001) and presence of intraventricular hemorrhage (p = 0.02). Lower ICH scores were more frequent in those that arrived late. Fourteen patients showed hematoma enlargement and the majority of them (n = 13) were admitted within the first 3 h from symptom onset (p = 0.01). Patients who arrived within the 3-hour window had a higher 30-day mortality (p = 0.0008) and a worse Rankin score after 6 months (p = 0.001).


CONCLUSIONS
Treatment decisions in acute ICH may need to establish new combined approaches to maximize the number of eligible patients for early therapy considering the interactions between independent outcome predictors presented at early onset.
Valiente
Raul Alberto
RA
Hospital Santa Marcelina, São Paulo, Brazil. rvaliente@uol.com.br
de Miranda-Alves
Maramélia Araújo
MA
Silva
Gisele Sampaio
GS
Gomes
Daniela Laranja
DL
Brucki
Sonia Maria Dozzi
SM
Rocha
Maria Sheila Guimarães
MS
Massaro
Ayrton Roberto
AR