Abstract Body: Introduction
Early interventions limit morbidity and mortality in ICH patients. Recognizing epidemiological risk factors in local communities helps target specific populations through community education and implement appropriate healthcare delivery measures. We investigated ICH patients presenting and referred to a large “hub and spoke” model comprehensive stroke center in North Texas.
Methods
Patients admitted directly to the “hub” hospital (via emergency medical services, EMS or private transportation, PT) and transferred from a “spoke” hospital (ST) were investigated. Door-in-door-out (DIDO) time was used to estimate delay at the referring hospital. ICH score estimated disease severity and modified Rankin score (mRS) at discharge defined patient outcome. Comparison between race/ethnicity [i.e., non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanics (HP)] and mode of presentation [i.e., EMS, PT, ST] were performed using Chi-square test and one-way ANOVA.
Results
Of the 448 ICH patients admitted over 2.5 years, 170 (37.9%) were NHW, 146 (32.6%) were NHB, and 106 (23.7%) were HP. HP patients were younger compared to other racial cohorts [NHW vs. NHB vs. HP – 69.5 (IQR, 58.5, 79.0) vs. 58.0 (50.5, 67.5) vs. 56.0 (47.0, 67.0), p<0.0001] and had longer length of stay (LOS) [NHW vs. NHB vs. HP – 6 (3, 12) vs. 8 (4.5, 16) vs. 10 (6, 23), p<0.0001] despite similar admission severity, outcome and in-hospital mortality. Two hundred and sixteen patients (48.2%) presented to the hub hospital via EMS and 51 (11.3%) via PT compared to 141 (31.7%) transfer-ins from spoke hospitals. Median DIDO at the spoke hospital was 146 min (107, 226). Patients presenting to hub hospital had higher ICH scores [HT vs PT vs ST – 2 (1,3) vs. 0 (0,1) vs. 1 (0,2), p<0.0001] and had longer LOS [HT vs. PT vs. ST – 10 (6, 21.5) vs 6 (3, 9) vs 7 (3, 4.5), p<0.0001] and higher discharge mRS [HT vs PT vs ST – 4 (4, 6) vs 3 (2, 4) vs 4 (4, 12.5), p<0.0001].
Conclusion
Our regional cohort identifies an early age for ICH occurrence in the HP population. Patients with higher ICH scores presenting directly to the hub hospital could explain increased LOS and adverse clinical outcomes in this sub-cohort. More extensive registry-based or prospective studies are needed to validate these findings.