Abstract 3858: Evaluation of Serial Neuroimaging in Patients with Intracerebral Hemorrhage
Introduction: The availability of sophisticated neuroimaging has led to increased utilization of imaging studies, particularly at comprehensive stroke centers. This increase in advanced imaging contributes to healthcare costs and has been questioned in this era of reducing reimbursement.
Hypothesis: Multiple neuroimaging studies have limited impact in determining the plan of care for most patients with intracerebral hemorrhage.
Methods: An IRB-approved retrospective chart review of all patients with Intracerebral Hemorrhage (ICH, ICD 431) treated at UH-CMC in 2010 collected data on demographics, number of neuroimaging studies and imaging characteristics, and the impact of testing on determining a medical or surgical plan of care. Hemorrhage location dictated one of two groups: basal ganglia and thalamus (BG) versus IVH alone, infratentorial and lobar (NBG).
Results: Data was available on 120 (86%) of patients; 74 (62%) were male. Mean volume of ICH on initial CT was significantly smaller at 8.5±11.7cc in 41 BG patients vs 63±27cc in 79 NBG patients (p=0.01). The decision to pursue surgical treatment (extraventricular drainage in 14, craniotomy in 9, or both in 4) was determined prior to a third neuroimaging study. Three or more neuroimaging studies were obtained in 56% of BG and 59% of NBG patients. Hematoma expansion was less likely to occur in BG vs NBG patients, both for significant hematoma expansion (>33% or +12.5cc increase, 5% vs 22%, p=0.05) and nonsignificant hematoma expansion (10-33% increase, 2.4% vs 8.9%, p=0.27). Hematoma expansion was exclusively within the first 2 imaging studies for BG patients but occurred in a delayed fashion in 3 (4%) of NBG patients. MRI was obtained in 17% of BG and 44% of NBG patients; only in 3 of the NBG patients did it identify a vascular malformation which led to surgery in 1 patient.
Conclusion: Although more than half of patients with intracerebral hemorrhage underwent three or more neuroimaging studies, 95% of patients’ care plan decisions were determined by the first, and to a lesser extent, the second neuroimaging study. Serial neuroimaging after the second study was of no value in patients with small basal ganglia hemorrhages and impacted the care plan in less than 10% of patients with hemorrhages in alternate locations. Our data suggests many neuroimaging studies can be safely omitted.
- © 2012 by American Heart Association, Inc.