Prolonged time to diagnosis of intracerebral haemorrhage (ICH) can result in delays in obtaining appropriate blood pressure control, reversal of coagulopathy or surgical intervention in select cases. We sought to characterise the time to diagnosis in a cohort of patients with ICH and identify factors associated with delayed diagnosis.
The stroke database of our hospital was retrospectively reviewed to identify patients presenting to our hospitals emergency department with ICH from January 2017 until December 2018. Data collected included demographics (age and sex), comorbidities, anticoagulation status, clinical (NIHSS, GCS, ICH score), imaging (anatomical site, haematoma size). Time of symptom onset imaging diagnosis was recorded. Factors associated with diagnosis >24 hours post ictus were assessed using t-tests and chi squared tests.
235 patients were identified with 125 males (53%) and a median age of 76 (range 40-98). Mean NIHSS score at presentation was 14.3 ± 10.4, and mean ICH score was 1.9 (± 1.4). In 148 (63%) cases hypertension was the aetiology. The site of haemorrhage was lobar in 96 (41%), deep cerebral in 106 (45%), cerebellar in 23 (10%) and brainstem in 10 (4%). 134 (57%) were diagnosed within ≤6 hours of ictus, 77 (33%) at 6-24 hours and 24 (10%) were diagnosed >24 hours post ictus. Factors associated with delayed diagnosis included lower NIHSS (p=0.01), absence of hemiplegia (p=0.01) and a code stroke not being called (p=0.01).
The majority of patients with ICH present within 6 hours of ictus. Cases of delayed diagnosis involved patients with less prominent clinical deficits.