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The association between on-scene blood pressure and early neurological deterioration in patients with spontaneous intracerebral haemorrhage
  1. Ju-Sing Fan1,2,
  2. Yen-Chia Chen1,2,
  3. Hsien-Hao Huang1,2,
  4. Chorng-Kuang How1,2,
  5. David Hung-Tsang Yen1,3,
  6. Mu-Shun Huang1,2
  1. 1Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
  2. 2Department of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
  3. 3Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan, R.O.C
  1. Correspondence to Dr David Hung Tsang Yen, Department of Emergency Medicine, Taipei-Veterans General Hospital, 201 Sec 2, Shih-Pai Road, Taipei, Taiwan, R.O.C.; 11217 hjyen{at}vghtpe.gov.tw

Abstract

Objective To determine whether on-scene BP is associated with early neurological deterioration (END) in patients with spontaneous intracerebral haemorrhage (SICH).

Methods This retrospective cohort study enrolled consecutive ambulance-transported adult SICH patients treated at our emergency department (ED) from January 2007 through December 2012. END was defined as a ≥2-point decrease in GCS within 24 h of ED arrival. The exact relationship between on-scene BP and END was assessed using multiple logistic regression analyses for adjusting age, gender, Charlson Index, aspirin use, smoking, elapsed time, consciousness level on ED arrival, haematoma size, intraventricular extension, midline shift and infratentorial ICH. We further calculated the −2 log-likelihood decrease for each regression model incorporated with the BP values measured at different times to compare model fitness.

Results After adjusting for the covariates, on-scene systolic BP (by 10 mm Hg incremental: OR = 1.126, 95% CI 1.015 to 1.265), diastolic BP (by 10 mm Hg incremental: OR=1.146, 95% CI 1.019 to 1.303) and mean arterial pressure (MAP) (by 10 mm Hg incremental: OR=1.225, 95% CI 1.057 to 1.443) were significantly associated with END; adding on-scene MAP into the regression model yielded the highest model fitness increase. Adding on-scene BPs into the regression model yielded higher model fitness increase than adding ED and admission BPs.

Conclusions Few on-scene BP indices were associated with neuroworsening within 24 h after ED arrival in non-comatose SICH patients. Compared with BP measured on ED arrival or admission, on-scene BP had a stronger correlation with END.

  • Emergency Ambulance Systems
  • Neurology, Stroke
  • Prehospital Care

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