Hyperacute Neurologic Changes and Outcome after Intracerebral Hemorrhage (P7.136)

Objective: We sought to determine the temporal pattern of early neurologic changes in intracerebral hemorrhage (ICH), and the impact of those early neurologic changes on long-term functional outcomes. Background: Early interventions for ICH seek to limit evolving neurologic injury, yet there is limited data to characterize the timing of neurologic changes after symptom onset. Further, common risk adjustment models for ICH incorporate only admission data, and little is known about the added impact of early in-hospital changes on outcomes. Design/Methods: We enrolled cases of spontaneous ICH in a prospective observational study. Patients were managed with an intensive care unit protocol that included hourly neurochecks utilizing the Glasgow Coma Scale (GCS). We determined the rate of GCS changes and casewise neurologic change detected per patient-hour of monitoring to identify the hyperacute phase. We used a multivariate regression model to test whether hyperacute GCS changes were independently associated with 3 month outcome measured by the modified Rankin Scale (mRS). Results: We studied 13025 patient-hours of monitoring from 132 cases. The rate of neurologic change was initially 1.0 GCS points per patient-hour of monitoring (0 to 3 hours from symptom onset), and diminished rapidly to a baseline of 0.1 GCS points per patient-hour beyond 12 hours from symptom onset (p<0.05 for time intervals before 12 hours). Hyperacute change in GCS score was an independent predictor of functional outcomes at three months as measured by mRS (odds ratio 0.81 [95% confidence interval 0.66-0.99], p=0.043) after adjustment for age, hematoma volume, supratenorial versus infratentorial location, initial GCS and intraventricular hemorrhage. Conclusions: The first 12 hours after ICH onset is a time of rapid neurologic changes that significantly impact patients’ long-term functional outcomes. Neuromonitoring may impact patient care the most during this 12 hour hyperacute period. Study supported by NIH grant L30NS080176 (Dr. Maas). Disclosure: Dr. Maas has nothing to disclose. Dr. Berman has nothing to disclose. Dr. Guth has nothing to disclose. Dr. Liotta has nothing to disclose. Dr. Prabhakaran has received personal compensation for activities with American Heart Association. Dr. Naidech has received research support from Gaymar Inc.