title: The association between on-scene blood pressure and early neurological deterioration in patients with spontaneous intracerebral haemorrhage.
abstract: OBJECTIVE
  To determine whether on-scene BP is associated with early neurological deterioration (END) in patients with spontaneous intracerebral haemorrhage (SICH).
  
  
  METHODS
  This retrospective cohort study enrolled consecutive ambulance-transported adult SICH patients treated at our emergency department (ED) from January 2007 through December 2012. END was defined as a ≥2-point decrease in GCS within 24 h of ED arrival. The exact relationship between on-scene BP and END was assessed using multiple logistic regression analyses for adjusting age, gender, Charlson Index, aspirin use, smoking, elapsed time, consciousness level on ED arrival, haematoma size, intraventricular extension, midline shift and infratentorial ICH. We further calculated the -2 log-likelihood decrease for each regression model incorporated with the BP values measured at different times to compare model fitness.
  
  
  RESULTS
  After adjusting for the covariates, on-scene systolic BP (by 10 mm Hg incremental: OR = 1.126, 95% CI 1.015 to 1.265), diastolic BP (by 10 mm Hg incremental: OR=1.146, 95% CI 1.019 to 1.303) and mean arterial pressure (MAP) (by 10 mm Hg incremental: OR=1.225, 95% CI 1.057 to 1.443) were significantly associated with END; adding on-scene MAP into the regression model yielded the highest model fitness increase. Adding on-scene BPs into the regression model yielded higher model fitness increase than adding ED and admission BPs.
  
  
  CONCLUSIONS
  Few on-scene BP indices were associated with neuroworsening within 24 h after ED arrival in non-comatose SICH patients. Compared with BP measured on ED arrival or admission, on-scene BP had a stronger correlation with END.
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. Department of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
authors.forename: Ju-Sing
authors.initials: JS
authors.lastname: Fan
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. Department of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
authors.forename: Yen-Chia
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. Department of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
authors.forename: Hsien-Hao
authors.initials: HH
authors.lastname: Huang
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. Department of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
authors.forename: Chorng-Kuang
authors.initials: CK
authors.lastname: How
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan, R.O.C.
authors.forename: David Hung-Tsang
authors.initials: DH
authors.lastname: Yen
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. Department of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
authors.forename: Mu-Shun
authors.initials: MS
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000503:physiopathology*; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Emergency Ambulance Systems; Neurology, Stroke; Prehospital Care