Abstract W MP116: Goals of Care Impact Early Outcome Estimates in Intracerebral Hemorrhage
Background/Objective: Prior reports of ICH score-based early mortality rates included patients declared comfort measures only (CMO). We aimed to describe more clinical relevant mortality and functional outcomes restricted to patients in whom all care was continued (non-CMO).
Methods: Using a single-center retrospective study design, admission ICH score, goals of care, hospital death (HD), and modified Rankin scale (mRS) at discharge were collected in patients with spontaneous ICH from June 2005 to September 2008. Use of CMO and proportions of outcome measures, stratified by admission ICH score, were compared using Pearson’s chi-square test statistics.
Results: Of 657 patients with ICH, 56.5% were male, 74.7% Caucasian, with mean (SD) age of 66.6 (14.6) years. CMO was pursued in 30.6% of all patients, with a significant increase in use associated with increasing age (p=0.021) and increasing ICH score (p<0.001). HD occurred in 33.8% of all patients, but only 7.2% of non-CMO. In the non-CMO patients, the association between HD and ICH score remained significant (p<0.001), though values were substantially lower than those including CMO patients. An improved distribution of mRS at discharge, in non-CMO patients, was significantly associated with lower ICH score, (p<0.001).
Conclusions: A significant association exists between ICH score on admission and decision for CMO. Although hospital discharge outcomes (death and mRS) worsen with increasing ICH score even in non-CMO patients, they are substantially improved compared to estimates which include CMO patients, including the original ICH cohorts in the literature. These findings have important implications for early discussions with families related to prognostication and decisions regarding goals of care, especially given a new mandate from The Joint Commission for reporting ICH scores at Comprehensive Stroke Centers.
Author Disclosures: R. Kalani: None. A. deHavenon: None. C. Creutzfeldt: None. W.T. Longstreth: None. A. Sultan-Qurraie: None. A. Huffer: None. K. Becker: None. D. Tirschwell: None.
- © 2015 by American Heart Association, Inc.