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Original article
peer-reviewed

Prehospital Systolic Hypertension and Outcomes in Patients with Spontaneous Intracerebral Hemorrhage



Abstract

Background

It is well known that hematoma volume and expansion is associated with poor outcomes in patients with spontaneous intracerebral hemorrhage (sICH). The factors associated with hematoma volume and possible expansion include the use of anticoagulant medications, autoimmune or bacterial diseases that reduce platelet production, and genetic defects of Von Willebrand factor causing inhibition or reduction of platelet aggregation.

However, little is known about the role of elevated systolic blood pressure (SBP) on hematoma volume and its ultimate role on sICH when identified in the prehospital setting. Our objectives were to determine the prevalence of elevated SBP among diagnosed sICH patients transported by emergency medical services (EMS), and to explore possible associations between prehospital elevated SBP and hematoma volume.

Methods

This is a hypothesis-generating study for which we used a retrospective observational design. The subjects included 243 adult patients who were seen and treated for sICH in an emergency department serving a county hospital in a large metropolitan city. Elevated SBP in the setting of sICH was defined as ≥140 mm Hg. A univariate analysis was performed to investigate associations between patient demographics, elevated SBP, and sICH characteristics with the pre-determined outcome of hematoma volume. We then performed a multivariable logistic regression model to determine if elevated prehospital SBP remained associated with hematoma volume.

Results

The number of subjects with a hospital-based diagnosis of sICH was 243. Of those, 193 (79%) were transported by an ambulance. Among those transported by ambulance, 180 (93%) had a documented prehospital SBP; out of those patients with a documented SBP, 173 (96%) showed an elevated SBP of ≥140 mm Hg, and 82 (46%) had a hematoma volume of ≥30 mL.

Our univariate analysis showed that sICH patients with an elevated prehospital SBP of ≥140 mm Hg were associated with hematoma volume. The multivariable regression model showed that elevated prehospital SBP (≥140 mm Hg) was associated with larger hematoma volumes (odds ratio (OR) 3.86 95% confidence interval (CI) 1.02-4.60).

Conclusions

Prehospital elevated SBP is associated with larger hematoma volume in patients with sICH. Future studies should confirm these findings in a larger cohort of patients.



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Original article
peer-reviewed

Prehospital Systolic Hypertension and Outcomes in Patients with Spontaneous Intracerebral Hemorrhage


Author Information

Stacy Hatcher Corresponding Author

Department of Surgery, University of California San Francisco

Connie Chen

Internal Medicine, Stanford Healthcare

Prasanthi Govindarajan

Emergency Medicine, Stanford Healthcare


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Committee on Human Research of the University of California San Francisco. issued approval 10-04239. All aspects of this study were approved by the Committee on Human Research of the University of California, San Francisco. . Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

The authors would like to acknowledge J. Claude Hemphill III, MD, MAS with the University of California, San Francisco, Department of Neurology and Neurosurgery, San Francisco General Hospital for providing the database used in this study.


Original article
peer-reviewed

Prehospital Systolic Hypertension and Outcomes in Patients with Spontaneous Intracerebral Hemorrhage


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Original article
peer-reviewed

Prehospital Systolic Hypertension and Outcomes in Patients with Spontaneous Intracerebral Hemorrhage

  • Author Information
    Stacy Hatcher Corresponding Author

    Department of Surgery, University of California San Francisco

    Connie Chen

    Internal Medicine, Stanford Healthcare

    Prasanthi Govindarajan

    Emergency Medicine, Stanford Healthcare


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Committee on Human Research of the University of California San Francisco. issued approval 10-04239. All aspects of this study were approved by the Committee on Human Research of the University of California, San Francisco. . Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    The authors would like to acknowledge J. Claude Hemphill III, MD, MAS with the University of California, San Francisco, Department of Neurology and Neurosurgery, San Francisco General Hospital for providing the database used in this study.


    Article Information

    Published: January 26, 2017

    DOI

    10.7759/cureus.998

    Cite this article as:

    Hatcher S, Chen C, Govindarajan P (January 26, 2017) Prehospital Systolic Hypertension and Outcomes in Patients with Spontaneous Intracerebral Hemorrhage . Cureus 9(1): e998. doi:10.7759/cureus.998

    Publication history

    Received by Cureus: September 14, 2016
    Peer review began: September 28, 2016
    Peer review concluded: January 18, 2017
    Published: January 26, 2017

    Copyright

    © Copyright 2017
    Hatcher et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background

It is well known that hematoma volume and expansion is associated with poor outcomes in patients with spontaneous intracerebral hemorrhage (sICH). The factors associated with hematoma volume and possible expansion include the use of anticoagulant medications, autoimmune or bacterial diseases that reduce platelet production, and genetic defects of Von Willebrand factor causing inhibition or reduction of platelet aggregation.

However, little is known about the role of elevated systolic blood pressure (SBP) on hematoma volume and its ultimate role on sICH when identified in the prehospital setting. Our objectives were to determine the prevalence of elevated SBP among diagnosed sICH patients transported by emergency medical services (EMS), and to explore possible associations between prehospital elevated SBP and hematoma volume.

Methods

This is a hypothesis-generating study for which we used a retrospective observational design. The subjects included 243 adult patients who were seen and treated for sICH in an emergency department serving a county hospital in a large metropolitan city. Elevated SBP in the setting of sICH was defined as ≥140 mm Hg. A univariate analysis was performed to investigate associations between patient demographics, elevated SBP, and sICH characteristics with the pre-determined outcome of hematoma volume. We then performed a multivariable logistic regression model to determine if elevated prehospital SBP remained associated with hematoma volume.

Results

The number of subjects with a hospital-based diagnosis of sICH was 243. Of those, 193 (79%) were transported by an ambulance. Among those transported by ambulance, 180 (93%) had a documented prehospital SBP; out of those patients with a documented SBP, 173 (96%) showed an elevated SBP of ≥140 mm Hg, and 82 (46%) had a hematoma volume of ≥30 mL.

Our univariate analysis showed that sICH patients with an elevated prehospital SBP of ≥140 mm Hg were associated with hematoma volume. The multivariable regression model showed that elevated prehospital SBP (≥140 mm Hg) was associated with larger hematoma volumes (odds ratio (OR) 3.86 95% confidence interval (CI) 1.02-4.60).

Conclusions

Prehospital elevated SBP is associated with larger hematoma volume in patients with sICH. Future studies should confirm these findings in a larger cohort of patients.



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Create a free account to continue reading this article.

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Stacy Hatcher

Department of Surgery, University of California San Francisco

For correspondence:
stacy.hatcher@ucsf.edu

Connie Chen

Internal Medicine, Stanford Healthcare

Prasanthi Govindarajan, M.D., M.Sc., Associate Professor

Emergency Medicine, Stanford Healthcare

Stacy Hatcher

Department of Surgery, University of California San Francisco

For correspondence:
stacy.hatcher@ucsf.edu

Connie Chen

Internal Medicine, Stanford Healthcare

Prasanthi Govindarajan, M.D., M.Sc., Associate Professor

Emergency Medicine, Stanford Healthcare