The influence of direct transportation to neurosurgical-capable medical centers on the clinical outcomes of patients with spontaneous intracerebral hemorrhage in urban area: a two-center retrospective study.

INTRODUCTION

Spontaneous intracranial hemorrhage (ICH) is one of the major causes of morbidity and mortality worldwide due to its poor clinical outcomes. Recent guidelines recommend transferring to medical centers with neurosurgical capabilities to improve outcomes, but it remains unclear whether centers that do not have such neurosurgical capabilities should be bypassed. The current study analyzed the effect of direct transportation to neurosurgical-capable centers on patients with spontaneous ICH in the urban area of Southeast China.

METHODS

We included 143 adult patients with spontaneous ICH admitted to two neurosurgical-capable centers from January 2022 to December 2024.

RESULTS

A total of 33 patients were transferred from local centers without neurosurgical capabilities, and 110 of them were admitted directly. The patients had similar baseline characteristics and initial status upon admission. Patients transferred from local centers had a shorter time interval between Emergency Medical Service (EMS) initiation and first computed tomography (CT) scan (0.9 ± 0.3 h vs. 1.7 ± 0.6 h,  < 0.001) but a longer time interval before arriving at a neurosurgical-capable center (1.6 ± 0.4 h vs. 1.4 ± 0.6 h,  = 0.047). Clinical outcomes, including in-hospital mortality and Glasgow Outcome Scale (GOS) score upon discharge, indicated no statistical difference between the groups, regardless of whether the patients underwent neurosurgical operations or not.

DISCUSSION

In conclusion, the strategy of direct transportation to neurosurgical-capable centers in urban areas did not improve clinical outcomes among patients with ICH; therefore, transfer from local centers after primary diagnosis might be an acceptable strategy.