ISSN: 0034-8376
eISSN: 2564-8896





Hospital Arrival and Functional Outcome after Intracerebral Hemorrhage




José L. Ruiz-Sandoval, Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal.; Department of Neurosciences, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal., Mexico Javier Aceves-Montoya, Department of Medicine, Universidad Autónoma de Sinaloa, Sin., Mexico Erwin Chiquete, Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico Germán López-Valencia, Department of Neurosciences, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal., Mexico Alejandro Lara-López, Department of Physiology, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jal., Mexico Manuel Sánchez-González, Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal., Mexico Amado Jiménez-Ruiz, Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jal., Mexico Fernando Barinagarrementería, Department of Neurology, Hospital H+, Querétaro, Qro., Mexico Luis Murillo-Bonilla, Department of Neurology, Facultad de Medicina, Universidad Autónoma de Guadalajara, Guadalajara, Jal., Mexico Antonio Arauz-Góngora, Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico Fernando Daniel Flores-Silva, Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico Carlos Cantú-Brito, Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico


Background: Intracerebral hemorrhage (ICH) is associated with an ominous outcome influenced by the time to hospital presentation. Objective: This study aims to identify the factors that influence an early hospital arrival after ICH and the relationship with outcome. Methods: In this multicenter registry, patients with confirmed ICH on CT scan and well-known time of symptoms onset were studied. Clinical data, arrival conditions, and prognostic scores were analyzed. Multivariate models were built to find independent predictors of < 6 h arrival (logistic regression) and in-hospital death (Cox proportional-hazards model). Results: Among the 473 patients analyzed (51% women, median age 63 years), the median delay since onset to admission was 6.25 h (interquartile range: 2.5-24 h); 7.8% arrived in < 1 h, 26.3% in < 3 h, 45.3% in < 6 h, and 62.3% in < 12 h. The in-hospital, 30-day and 90-day case fatality rates were 28.8%, 30.0%, and 32.6%, respectively. Predictors of arrival in < 6 h were hypertension treatment (odds ratios [OR]: 1.675, 95% confidence intervals [CI]: 1.030-2.724), >- 3 years of schooling (OR: 1.804, 95% CI: 1.055-3.084), and seizures at ICH onset (OR: 2.416, 95% CI: 1.068-5.465). Predictors of death (56.9% neurological) were systolic blood pressure > 180 mmHg (hazards ratios [HR]: 1.839, 95% CI: 1.031-3.281), ICH score >- 3 (HR: 2.302, 95% CI: 1.300-4.074), and admission Glasgow Coma Scale < 8 (HR: 4.497, 95% CI: 2.466-8.199). Early arrival was not associated with outcome at discharge, 30 or 90 days. Conclusions: In this study, less than half of patients with ICH arrived to the hospital in < 6 h. However, early arrival was not associated with the short-term outcome in this data set.



Keywords: Arrival. Cerebrovascular. Death. Intracerebral hemorrhage. Outcome. Stroke.