Abstract
Abstract only Introduction: The initial intent of the intracerebral hemorrhage (ICH) score was to improve communication and consistency among providers, rather than to be used as a precise predictor of outcome. We aimed to investigate time trends in rates of mortality and withdrawal of life-sustaining treatment (WLST) by category of ICH severity score. Methods: Patients with a recorded clinical diagnosis of ICH were identified using data from Florida Stroke Registry (FSR) hospitals participating in the American Heart Association (AHA) Get with the Guidelines- Stroke (GWTG-S). We included FSR patients from 2013-2022 who had ICH scores documented at presentation. Outcomes of WLST and in-hospital mortality were collected. ICH severity score was stratified into three groups: score 0-2; 3-4; 5-6. Importance plots were generated to identify the most predictive factors associated with WLST. AUC-ROC curves were generated for logistic regression (LR) and random forest (RF) models. Regression analysis was performed to evaluate temporal trends. Results: A total of 12,426 (26%) patients had documented ICH scores. Mean age was 69 (SD = 14.96), 55% male, 56% White, and 20% Hispanic; 84% were treated in a comprehensive stroke center with 49% were Medicare-insured. Baseline characteristics were similar to patients without documented scores. The most predictive factors associated with WLST were ICH score, age, state region, presenting level of consciousness, insurance status and race (RF AUC=.94, LR AUC=.82). In-hospital mortality rate for ICH group 0-2 was 6.6%, 41.5% for group 3-4 and 66% for group 5-6; mortality rates decreased over time for ICH groups 0-2 (r 2 =.8, p<.001), 3-4 (r 2 =.4, p=.049), and 5-6 (r 2 =.35, p=.07). Rate of WLST was 12% for ICH group 0-2, 58% for group 3-4 and 71% for group 5-6. Overall WLST rate remained stable across ICH groups; rate of early WLST (< day 2) decreased for ICH score 0-2 (r 2 =.91, p<.001) and 3-4 groups (r 2 =.78, p=.004). Conclusion: Among patients admitted across multiple centers in Florida with documented ICH scores, we noted an overall improvement in in-hospital mortality between 2015-2022, along with slight increase in rates of WLST across ICH severity scores. Early rates of WLST did appear to decrease for lower ICH score severities but remained stable for higher ICH score patients. We identified the most predictive variable associated with WLST to be the ICH score. These findings suggest a continued influence of the self-fulfilling prophecy in ICH.