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• W2795653592 abstract "OBJECTIVE: To determine whether surveillance neuroimaging and examinations impact care for patients with intracerebral hemorrhage (ICH). BACKGROUND: The value of routinely performing serial neuroimaging and neurologic examinations to monitor patients after ICH is unknown. US and European guidelines only address imaging for purposes of diagnosis and determining etiology. We tested the hypothesis that a structured surveillance protocol of serial neuroimaging and neurological examinations identified clinical changes requiring emergent surgical interventions. DESIGN/METHODS: Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed in a dedicated neuroscience intensive care unit with a protocol that included routine serial neuroimaging at 6, 24 and 48 hours, and hourly serial neurologic examinations using the Glasgow Coma Scale and National Institutes of Health Stroke Scale. We evaluated all cases of craniotomy and ventriculostomy to determine whether the procedure was part of the initial management plan or was unplanned in the initial management. For those that were unplanned, we determined worsening on neurologic examination or worsened neuroimaging findings initiated the process leading to intervention. RESULTS: 239 patients were studied. There were 88 surgical interventions in 84 patients (35%), including ventriculostomy in 52 (59%), craniotomy in 21 (24%) and both in 11 (13%). Of the 88 interventions, 24 (27%) occurred subsequently and distinctly from initial management, a median of 15.9 hr [8.9-27.0 hr] after symptom onset. Thirteen (54%) were instigated by findings on neurologic examination and 11 (46%) by neuroimaging. Demographics, severity of hemorrhage and location of hemorrhage were not associated with delayed intervention. CONCLUSIONS: Over 25% of surgical interventions performed after ICH were distinct from the initial management plan, and prompted by delayed imaging or clinical findings. Serial neurologic examinations and serial neuroimaging are both important and effective surveillance techniques for monitoring patients with ICH. Supported by: Departmentally funded. Disclosure: Dr. Maas has nothing to disclose. Dr. Rosenberg has nothing to disclose. Dr. Kosteva has nothing to disclose. Dr. Bauer has nothing to disclose. Dr. Guth has nothing to disclose. Dr. Liotta has nothing to disclose. Dr. Prabhakaran has nothing to disclose. Dr. Naidech has received research support from Gaymar Inc." @default.
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• W2795653592 date "2013-02-12" @default.
• W2795653592 modified "2023-09-26" @default.
• W2795653592 title "Surveillance Neuroimaging and Neurologic Examinations Influence Management after Intracerebral Hemorrhage (S12.005)" @default.
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