Accessing Care for Intracerebral Hemorrhage: An Unexpected Paradox? (P3.095)

Objective: This study examines outcomes in mild to moderate severity ICH patients presenting to the ED by private car versus by EMS. Background: Use of EMS to access stroke care has been associated with improved outcomes in acute ischemic stroke. Design/Methods: We retrospectively analyzed consecutive ICH patients at our institution from 2008-2013. Patients were excluded if transferred to our institution from another facility, transitioned to palliative care or had severe stroke (NIHSS 蠅15). We compared demographics, vascular risk factors, stroke severity, and short-term functional outcome (defined as discharge mRS of 4-6) in patients arriving by private vehicle and patients arriving by EMS (ground or air). Results: Of 383 ICH patients, 114 patients met criteria for this analysis (mean age 63, 56[percnt] black, 44[percnt] female). Over one fourth arrived by private vehicle (30[percnt]). The two groups did not differ with respect to age (p=0.396), race (p=0.227) or sex (p=0.586). Patients arriving by EMS had significantly higher stroke severity as measured by the GCS (range 6-15 vs. 10-15, p=0.022) and NIHSS (range 1-14 vs. 0-9, p<0.001). At the time of discharge, patients arriving by EMS required more oral antihypertensives (range 0-6 vs. 0-4, p=0.037). NIHSS was found to be such a strong confounder that our combination of restriction and adjustment methods were unable to completely resolve the imbalance between groups (data not shown). Conclusions: Our data suggest that patients arriving by private vehicle were at lower odds of having an unfavorable outcome at discharge. Although this appears to be a paradox to traditional public health teaching, in reality, we would argue that patients presenting by private car should not be directly compared to patients arriving by EMS. Future research should be cognizant of this potential pitfall in an effort to avoid reporting erroneous relationships. Disclosure: Dr. Lyerly has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Bavarsad Shahripour has nothing to disclose. Dr. Sands has nothing to disclose. Dr. Shiue has nothing to disclose. Dr. Sisson has nothing to disclose. Dr. Harrigan has nothing to disclose.