Predicting the Likelihood of Neurosurgical Intervention Prior to Transfer of Spontaneous Intracerebral Hemorrhage (ICH) to Tertiary Care Facilities Using Data From a Retrospective Cohort: The Likelihood of Neurosurgery Score (LoNS)
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Patients with spontaneous intracranial hemorrhage (ICH) who present to non-tertiary care centers are often transferred to a facility with neurosurgical expertise without consideration of the likelihood of surgical intervention. At our Comprehensive Stroke Center (CSC), a minority of patients transferred for neurosurgical evaluation undergo interventions putting a strain on hospital resources. This study aimed to (1) quantify the frequency of neurosurgical intervention in ICH patients transferred to our hospital and, (2) to develop a tool to aid in transfer decisions. Methods: Using an IRB-approved retrospective cohort study design, we identified all spontaneous ICH patients transferred to our CSC between January 1, 2016, and May 31, 2023. All patients were reviewed to ensure a primary diagnosis of non-traumatic supratentorial ICH. Odds ratios were calculated using a logistic regression model to identify factors predictive of neurosurgery which were weighted by strength of association. Internal validation was then performed. Results: Of the 496 participants included in the final dataset, 78 (15.7%) underwent neurosurgical intervention. Age, Glasgow Coma Scale, ICH volume, and intraventricular extension were the greatest predictors of neurosurgery. These factors were used to create the Likelihood of Neurosurgery Score (LoNS), a weighted score used to inform transfer decisions. The score performed well on calibration and discrimination tests. Conclusion: The LoNS is a new tool to identify ICH patients unlikely to be neurosurgical candidates who could be safely managed at the local level rather than urgently transferred to a tertiary care center. Prospective validation is needed.
Source: The Neurohospitalist
Authors: Jane Morris, Samantha Barry, Jared Sawyer, Duncan Birkbeck, Wendy Y. Craig, Madeleine M Puissant
Institutions: Tufts University, MaineHealth, Maine Medical Center, Brown University
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Award: G3555172481
OpenAlex ID: W4415639581