DUGi

Effect of prehospital transfer model in patients with intracerebral hemorrhage: a RACECAT sub-analysis

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Background: RACECAT was the first randomized study, in our territory, designed to evaluate if in nonurban areas with limited access to thrombectomy-capable centers, patients with large vessel occlusion would benefit from going directly to a center with the capacity to perform a mechanical thrombectomy compared with transport them to the closest local stroke center. 1401 patients were randomized into two groups: one group followed the usual route to the nearest stroke center (drip-and-ship model) and the other group was sent directly to a thrombectomy-capable center (mothership model). The scale used to recognize patients with LVO (RACE scale >4) did not allow differentiation between ischemic and hemorrhagic strokes, and therefore, 314 patients with intracerebral hemorrhage were included in the study. This meant that approximately half of these patients were referred to a more distant center with an average delay in hospital care of 49 minutes more than the group that went to the nearest stroke center. Intracerebral hemorrhage is a devastating type of stroke and during the first 3 hours, neurological deterioration can occur, mostly due to hematoma expansion. Early and intensive blood pressure control has proven to be effective in tapering hematoma expansion, especially during the first hours. Objective: The aim of this study is whether bypassing the nearest local stroke center is harmful to patients suffering an intracerebral hemorrhage. Our main objective is to compare the Rankin score at 90 days of patients with intracerebral hemorrhage according to the prehospital circuit (drip-and-ship vs. mothership) they had in the RACECAT study. Design: This study will be a retrospective subanalysis of RACECAT prospective cohorts. It is a multicenter study that includes 28 centers in Catalonia. Participants: Patients older than 18 years old with intracerebral hemorrhage previously included in the RACECAT study. Methods: All the data needed is going to be collected from the CICAT database. For the statistical analysis, we will use χ2-test and Exact Fisher test for qualitative variables, Mann-Whitney for discrete quantitative variables, and T-student to compare qualitative with quantitative variables. A confidence interval of 95% will be assumed and a p<0,05 will be considered statistically significant. The association between the independent and the dependent variables will be adjusted by a logic regression and general linear models in order to avoid possible confounders or effect modifiers

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