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Interhospital transfer neurological deterioration in patients with spontaneous intracerebral haemorrhage: incidence and risk factors
  1. Ju-Sing Fan1,2,
  2. Yen-Chia Chen1,2,
  3. Hsien-Hao Huang1,2,
  4. David Hung-Tsang Yen1,3,
  5. Chorng-Kuang How1,2,
  6. Mu-Shuan Huang1,2
  1. 1Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2School of Medicine, National Yang-Ming University, Taipei, Taiwan
  3. 3Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
  1. Correspondence to Dr David Hung Tsang Yen, Department of Emergency Medicine, Taipei Veterans General Hospital, 201 Sec 2, Shih-Pai Rd, Taipei, Taiwan; hjyen{at}


Objective To explore the incidence and risk factors for interhospital transfer neurological deterioration (IHTND) in patients with spontaneous intracerebral haemorrhage (SICH).

Methods Consecutive adult patients with first-ever SICH referred to our emergency department (ED) and transported by ambulance from July 2011 through June 2015 were eligible for this prospective observational study. Enrolled patients had SICH with elapsed time <12 hours and a nearly normal Glasgow Coma Scale (GCS) score (≥13) at presentation. IHTND was defined as GCS score drop ≥2 points during the time from last GCS measure in first ED (shortly before transport) and first measure in second ED (shortly after arrival), which was confirmed by the accompanying nurse practitioner. The potential risk factors for IHTND were screened by χ2 test, unpaired t test (parametric data) or Mann–Whitney U test (non-parametric data) in univariate analysis. Multiple logistic regression analysis was used to adjust for other covariates.

Results Among 217 enrolled patients, 36 (16.6%) had IHTND. After adjustment for other covariates in multiple logistic regression analysis, the significant predictors of IHTND were arrival systolic blood pressure ≥180 mm Hg (p=0.026, OR=2.741, 95% CI 1.126 to 6.674), infratentorial ICH (p=0.015, OR=3.182, 95% CI 1.248 to 8.113), presence of intraventricular haemorrhage (p=0.023, OR=2.533, 95% CI 1.137 to 5.645) and larger ICH (by 1 mL increment of haematoma, p=0.013, OR=1.027, 95% CI 1.006 to 1.048).

Conclusions About one-sixth of referred not comatose patients with SICH developed IHTND. Some risk factors were identified for the first time. Modifying procedures for proper transfer of patients at high-risk for IHTND might help in safely transferring patients with SICH.


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  • Contributors DHTY and JSF conceived and designed the study. CKH and MSH supervised the conduct of the investigation and data collection. JSF, DHTY, YCC, HHH and CKH undertook recruitment of participating patients and managed the data, including quality control. DHTY and YCC provided statistical advice on study design and analysed the data. JSF drafted the manuscript, and all authors contributed substantially to its revision.

  • Competing interests None declared.

  • Ethics approval IRB of Taipei Veterans General Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.