Neuroemergencies Management and Transfers System: Safety and Efficacy in Intracerebral Hemorrhage Patient Transfer During COVID-19 Pandemic.

Abstract

Intracerebral hemorrhage (ICH) carries significant morbidity and mortality. Efficient, resilient triage and transfer systems are critical, especially during global crises such as the COVID-19 pandemic. This study evaluates the Neuroemergencies Management and Transfers (NEMAT) program's safety and effectiveness for ICH patients requiring interhospital transfers (IHT), comparing immediate and long-term outcomes, symptomatic postoperative rebleed, home discharge, 30-day mortality, and 6-month modified Rankin Scale (mRS) scores between NEMAT and direct emergency department (ED) admissions. We analyzed a prospectively collected registry of ICH patients who underwent minimally invasive endoscopic evacuation at a large urban hospital (03/2017-04/2023). The cohort was categorized into 2 groups: direct ED admissions and NEMAT transfers, evaluated across 3 pandemic phases: pre-pandemic, first year, and second year. Statistical analyses utilized included univariate analyses and binary logistic regression validated through propensity score matching. Among 261 patients, 221 (85%) were NEMAT transfers; median age was 63 years (IQR: 54-74). Average transfer distance was 16.8 ± 56.6 km, duration was 1.6 ± 0.6 hours. Average times from symptom onset to leaving the referring hospital (bleed-to-door out time) were 32.8 ± 21.0 hours, and from arrival at first ED to departure from first ED (door-in-door-out time) were 4.9 ± 2.2 hours. The average time taken for the patient to leave the transferring facility (transfer out time) was 2.4 ± 1.4 hours. Binary logistic regression analyses found no significant impact of IHT via NEMAT on symptomatic postoperative rebleed (OR = 1.00; 95% CI: [0.99-1.01]; P = 0.99), home discharge disposition (OR = 0.92; 95% CI: [0.33-2.54]; P = 0.87), 30-day mortality (OR = 2.08; 95% CI: [0.26-16.8]; P = 0.49), or 6-month mRS (OR = 0.99; 95% CI: [0.34-2.86]; P = 0.98). This study supports the safety and viability of the NEMAT program for ICH management despite complexities introduced by the COVID-19 pandemic.