Abstract Body: Background: Minimally invasive surgical evacuation improved outcomes for patients with acute, spontaneous intracerebral hemorrhage (ICH) in the Early MiNimally-Invasive Removal of ICH (ENRICH) trial. Eligibility for this therapy amongst ICH patients encountered in routine clinical practice is unknown. Using a population-based study, we aimed to determine the percentage of patients with acute ICH eligible for minimally invasive surgical evacuation based on the ENRICH trial inclusion and exclusion (I/E) criteria.
Methods: We ascertained all adults (>18 years) with acute (<24 hours from LKW), spontaneous ICH presenting to the ED in Greater Cincinnati/Northern Kentucky in 2015. Cases were identified by ICD codes, clinical data abstracted, and physician adjudicated. Location and volume of ICH was centrally adjudicated by neuroradiologists. We sequentially applied clinically relevant ENRICH I/E criteria to calculate the percentage of patients excluded from minimally invasive surgical evacuation based on each criterion. We calculated conservative and liberal estimates of the percentage of patients with 1) any ICH, 2) lobar ICH, and 3) basal ganglia (BG) ICH eligible for minimally invasive surgical evacuation after application of ENRICH I/E criteria. Although lobar and BG ICH were both included in ENRICH, lobar and BG ICH were analyzed separately given the benefit of surgical hematoma evacuation was attributable to intervention for lobar ICH.
Results: Over the 2015 study period, we identified 197 patients presenting to the ED with acute, spontaneous ICH and no missing I/E criteria values. Median age was 74, 55% were female, 53% had lobar ICH, and 42% had deep cerebral ICH (12% BG ICH) (Table 1). The number of patients excluded after sequential application of each criterion is shown in Table 2. After application of all ENRICH I/E criteria, 3.0% (n= 6) of all acute ICH patients (5.7%, n=6 of lobar ICH and 0%, n=0 of BG ICH) were eligible for minimally invasive surgical evacuation. In a liberal estimate removing anticoagulant use, INR >1.4, mechanical valve, and ESRD as exclusion criteria, 3.6% (n= 7) of all acute ICH patients (6.7%, n =7 of lobar ICH and 0%, n=0 of BG ICH) were eligible for hematoma evacuation.
Conclusion: In a population-based study, only 3.0% of all acute ICH patients and 5.7% of lobar ICH patients were eligible for minimally invasive surgical evacuation. Further research is needed to establish effective therapies for more patients with acute ICH.