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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Neuroemergencies Management and Transfers System: Safety and Efficacy in Intracerebral Hemorrhage Patient Transfer
Bahie Ezzat1, Ryan Afreen1, Roshini Kalagara1
1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
The Neuroemergencies Management and Transfers (NEMAT) program safely transfers intracerebral hemorrhage (ICH) patients. This system proved effective during the COVID-19 pandemic, showing no adverse outcomes for transferred patients.
Area of Science:
- Neurosurgery
- Emergency Medicine
- Public Health
Background:
- Intracerebral hemorrhage (ICH) presents significant morbidity and mortality risks.
- Efficient triage and transfer systems are crucial, especially during global health crises like the COVID-19 pandemic.
- The Neuroemergencies Management and Transfers (NEMAT) program was developed to manage ICH patients requiring interhospital transfers (IHT).
Purpose of the Study:
- To evaluate the safety and effectiveness of the NEMAT program for ICH patients.
- To compare outcomes between patients transferred via NEMAT and those admitted directly to the emergency department (ED).
- To assess immediate and long-term outcomes, including symptomatic postoperative rebleed, home discharge, 30-day mortality, and 6-month modified Rankin Scale (mRS) scores.
Main Methods:
- Analysis of a prospectively collected registry of ICH patients undergoing minimally invasive endoscopic evacuation.
- Categorization of patients into direct ED admissions and NEMAT transfers.
- Evaluation across three pandemic phases (pre-pandemic, first year, second year) using univariate analyses and propensity score-matched binary logistic regression.
Main Results:
- Out of 261 patients, 221 (85%) were NEMAT transfers.
- NEMAT transfers showed no significant impact on symptomatic postoperative rebleed, home discharge, 30-day mortality, or 6-month mRS scores compared to direct ED admissions.
- Transfer times (bleed-to-door out, door-in-door-out, transfer out) were recorded and analyzed.
Conclusions:
- The NEMAT program demonstrates safety and viability for managing ICH patients.
- The program remained effective despite the complexities introduced by the COVID-19 pandemic.
- NEMAT facilitates critical interhospital transfers for neurosurgical emergencies.
Objective:
Intracerebral hemorrhage (ICH) carries significant morbidity and mortality. Efficient, resilient triage and transfer systems are critical, especially during global crises such as the COVID-19 pandemic. This study evaluates the Neuroemergencies Management and Transfers (NEMAT) program's safety and effectiveness for ICH patients requiring interhospital transfers (IHT), comparing immediate and long-term outcomes, symptomatic postoperative rebleed, home discharge, 30-day mortality, and 6-month modified Rankin Scale (mRS) scores between NEMAT and direct emergency department (ED) admissions.
Methods:
We analyzed a prospectively collected registry of ICH patients who underwent minimally invasive endoscopic evacuation at a large urban hospital (03/2017-04/2023). The cohort was categorized into 2 groups: direct ED admissions and NEMAT transfers, evaluated across 3 pandemic phases: pre-pandemic, first year, and second year. Statistical analyses utilized included univariate analyses and binary logistic regression validated through propensity score matching.
Results:
Among 261 patients, 221 (85%) were NEMAT transfers; median age was 63 years (IQR: 54-74). Average transfer distance was 16.8 ± 56.6 km, duration was 1.6 ± 0.6 hours. Average times from symptom onset to leaving the referring hospital (bleed-to-door out time) were 32.8 ± 21.0 hours, and from arrival at first ED to departure from first ED (door-in-door-out time) were 4.9 ± 2.2 hours. The average time taken for the patient to leave the transferring facility (transfer out time) was 2.4 ± 1.4 hours. Binary logistic regression analyses found no significant impact of IHT via NEMAT on symptomatic postoperative rebleed (OR = 1.00; 95% CI: [0.99-1.01]; P = 0.99), home discharge disposition (OR = 0.92; 95% CI: [0.33-2.54]; P = 0.87), 30-day mortality (OR = 2.08; 95% CI: [0.26-16.8]; P = 0.49), or 6-month mRS (OR = 0.99; 95% CI: [0.34-2.86]; P = 0.98).
Conclusions:
This study supports the safety and viability of the NEMAT program for ICH management despite complexities introduced by the COVID-19 pandemic.
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