An Intracerebral Hemorrhage Care Bundle Is Associated with Lower Case Fatality

作者：Adrian Parry‐Jones, Camilla Sammut‐Powell, Kyriaki Paroutoglou, Emily Birleson, Joshua Rowland, Stephanie J. Lee, Luca Cecchini, Mark Massyn, Richard Emsley, Benjamin Bray, Hiren C. Patel · 发表于：Annals of Neurology · 年份：2019 · DOI：10.1002/ana.25546 · 被引用次数：158 · 研究领域：Intracerebral and Subarachnoid Hemorrhage Research、Sepsis Diagnosis and Treatment、Acute Ischemic Stroke Management

OBJECTIVE: Anticoagulation reversal, intensive blood pressure lowering, neurosurgery, and access to critical care might all be beneficial in acute intracerebral hemorrhage (ICH). We combined and implemented these as the "ABC" hyperacute care bundle and sought to determine whether the implementation was associated with lower case fatality. METHODS: The ABC bundle was implemented from June 1, 2015 to May 31, 2016. Key process targets were set, and a registry captured consecutive patients. We compared 30-day case fatality before, during, and after bundle implementation with multivariate logistic regression and used mediation analysis to determine which care process measures mediated any association. Difference-in-difference analysis compared 30-day case fatality with 32,295 patients with ICH from 214 other hospitals in England and Wales using Sentinel Stroke National Audit Programme data. RESULTS: A total of 973 ICH patients were admitted in the study period. Compared to before implementation, the adjusted odds of death by 30 days were lower in the implementation period (odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.38-0.97, p = 0.03), and this was sustained after implementation (OR = 0.40, 95% CI = 0.24-0.61, p < 0.0001). Implementation of the bundle was associated with a 10.8 percentage point (95% CI = -17.9 to -3.7, p = 0.003) reduction in 30-day case fatality in difference-in-difference analysis. The total effect of the care bundle was mediated by a reduction in d...