Colantuono Paola, D'Anna Lucio, Foschi Matteo, Adipietro Michela, Lancia Stefania, Mammarella Leondino, Sacco Simona, Ornello Raffaele
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, L'Aquila, Italy.
Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London, United Kingdom.
Neurol Sci. 2025 Mar 31. doi: 10.1007/s10072-025-08113-x.
Comprehensive care bundles including rapid blood pressure management, anticoagulation reversal, neurosurgical consultation, control of blood glucose and body temperature, can improve short- and medium-term outcomes in patients with intracerebral hemorrhage (ICH). This study assessed how the acute management of ICH practices evolved in a real-world setting over five years characterized by global changes in ICH care.
This study analysed ICH cases from a population-based stroke registry between 2018 and 2022. We collected demographic and clinical data, focusing on key parameters of ICH management, such as systolic blood pressure, anticoagulation reversal, neurosurgical referrals, blood glucose, and body temperature. We also examined yearly trends in control of parameters over time.
We included 460 patients with ICH (55.4% male, median age 79 years, interquartile range 69-85). At onset, 266 patients (57.8%) had high SBP (SBP ≥ 140 mmHg), 286 (70.3%) hyperglycemia (blood glucose ≥ 108 mg/dL), and 63 (17.3%) hyperpyrexia (body temperature ≥ 37.0*C). Anticoagulation was reversed in 21.4% of anticoagulated patients within 24 h. Neurosurgical referrals were made for 84.6% of patients while only 12.4% underwent surgery. From 2018 to 2022, anticoagulation reversal rates increased from 0 to 88.9% (p < 0.001), while neurosurgical referrals not followed by surgery decreased from 79.5 to 55.7% (p < 0.001).
This real-world study demonstrates suboptimal management of key factors associated with ICH prognosis; nevertheless, it highlights improvement over time. There is a need for structured interventions to improve the timely and consistent application of simple yet effective measures yielding the potential to improve patients' outcomes.
包括快速血压管理、抗凝逆转、神经外科会诊、血糖和体温控制在内的综合护理方案，可改善脑出血（ICH）患者的短期和中期预后。本研究评估了在以ICH护理全球变化为特征的现实环境中，ICH急性管理实践在五年内是如何演变的。
本研究分析了2018年至2022年基于人群的卒中登记处的ICH病例。我们收集了人口统计学和临床数据，重点关注ICH管理的关键参数，如收缩压、抗凝逆转、神经外科转诊、血糖和体温。我们还研究了随着时间推移参数控制的年度趋势。
我们纳入了460例ICH患者（男性占55.4%，中位年龄79岁，四分位间距69 - 85岁）。发病时，266例患者（57.8%）收缩压高（收缩压≥140 mmHg），286例（70.3%）血糖高（血糖≥108 mg/dL），63例（17.3%）发热（体温≥37.0℃）。21.4%接受抗凝治疗的患者在24小时内实现了抗凝逆转。84.6%的患者进行了神经外科转诊，但只有12.4%的患者接受了手术。从2018年到2022年，抗凝逆转率从0%提高到88.9%（p < 0.001），而转诊后未接受手术的神经外科转诊率从79.5%降至55.7%（p < 0.001）。
这项现实世界研究表明，与ICH预后相关的关键因素管理欠佳；然而，它也突出了随着时间推移的改善。需要采取结构化干预措施，以改善简单而有效措施的及时和一致应用，从而有可能改善患者的预后。
