Abstract Body: Abstract
Introduction
The 2022 AHA/ASA Guidelines for Nontraumatic ICH recommend initiating blood pressure (BP) reduction within 2 hours of onset and achieving a target systolic BP of 130-150 mmHg within one hour of initiating a BP medication. This study evaluates the effectiveness of implementing ICH-specific time intervals, modeled after TARGET: STROKE, coupled with provider education to improve the timeliness of BP reduction in ICH patients.
Methods
Data were retrospectively collected at a CSC from 01/1/2021 to 12/31/2022 (pre-intervention) and from 1/1/2023 to 5/31/2024 (post-intervention). Emergency Department (ED) code stroke patients with an ICH were included. ED providers were given education on which BP intervals would be measured, and how to improve the timeliness of BP reduction. Baseline demographics, NIHSS, ICH volume, ICH score, 90-day mRS and door-to-BP reduction-related time metrics were collected. The data were analyzed using Kruskal-Wallis and Chi-square tests.
Results
91 code stroke patients presented to the ED with ICH. 32 pre- and 59 post-intervention. There were no differences between mean age, gender, race/ethnicity, NIHSS, ICH score or time from last known well to ED arrival between groups. Both groups had similar median ICH volumes; post- 18.4ml (IQR 5.2-44.7) vs. pre-intervention: 19.7ml (IQR 5.3-44.3) vs. (p=1.0). Door to first BP medication ordered was reduced to 13 (IQR 10.0-21.0) minutes post vs. 19 (IQR 14.5-25.5) minutes pre-intervention (p=0.007). Door to first BP medication administered was reduced to 21.0 (IQR 14.0-34.0) minutes post vs 29.5 (IQR 18.5-47.5) minutes pre-intervention (p=0.03). Time from first BP medication administration to goal SBP in rage of 130-150 improved to 43 minutes (IQR 33-52.3) post vs. 75 minutes (IQR 46.7-80) minutes pre-intervention. Door to first SBP in range of 130-150 mmHg improved to 60 minutes (IQR 46.0-80.0) post vs 98 minutes (IQR 69.5-141.0) pre-intervention p<0.0001. There were no differences in hematoma expansion or 90-day mRS between both groups, possibly due to the small sample size.
Conclusion
This is the first study to show that implementing ICH-specific time intervals in the ED, combined with provider education, effectively improve the timeliness of BP management in ICH patients. It highlights the value of ED education on guideline recommended time-targeted treatment of ICH care.