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An intracerebral hemorrhage care bundle is associated with lower case-fatality

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An intracerebral hemorrhage care bundle is associated with lower case-fatality. / Parry-Jones, Adrian R; Sammut-Powell, Camilla; Paroutoglou, Kyriaki; Birleson, Emily; Rowland, Joshua; Lee, Stephanie; Cecchini, Luca; Massyn, Mark; Emsley, Richard; Bray, Benjamin; Patel, Hiren.

In: Annals of Neurology, Vol. 86, No. 4, 01.10.2019, p. 495-503.

Research output: Contribution to journalArticle

Harvard

Parry-Jones, AR, Sammut-Powell, C, Paroutoglou, K, Birleson, E, Rowland, J, Lee, S, Cecchini, L, Massyn, M, Emsley, R, Bray, B & Patel, H 2019, 'An intracerebral hemorrhage care bundle is associated with lower case-fatality', Annals of Neurology, vol. 86, no. 4, pp. 495-503. https://doi.org/10.1002/ana.25546

APA

Parry-Jones, A. R., Sammut-Powell, C., Paroutoglou, K., Birleson, E., Rowland, J., Lee, S., ... Patel, H. (2019). An intracerebral hemorrhage care bundle is associated with lower case-fatality. Annals of Neurology, 86(4), 495-503. https://doi.org/10.1002/ana.25546

Vancouver

Parry-Jones AR, Sammut-Powell C, Paroutoglou K, Birleson E, Rowland J, Lee S et al. An intracerebral hemorrhage care bundle is associated with lower case-fatality. Annals of Neurology. 2019 Oct 1;86(4):495-503. https://doi.org/10.1002/ana.25546

Author

Parry-Jones, Adrian R ; Sammut-Powell, Camilla ; Paroutoglou, Kyriaki ; Birleson, Emily ; Rowland, Joshua ; Lee, Stephanie ; Cecchini, Luca ; Massyn, Mark ; Emsley, Richard ; Bray, Benjamin ; Patel, Hiren. / An intracerebral hemorrhage care bundle is associated with lower case-fatality. In: Annals of Neurology. 2019 ; Vol. 86, No. 4. pp. 495-503.

Bibtex Download

@article{72fd9616f6884e7db4190177cfdd51cb,
title = "An intracerebral hemorrhage care bundle is associated with lower case-fatality",
abstract = "OBJECTIVE: Anticoagulation reversal, intensive blood pressure lowering, neurosurgery and access to critical care might all be beneficial in acute intracerebral hemorrhage (ICH). We combined and implemented these as the 'ABC' hyperacute care bundle and sought to determine whether the implementation was associated with lower case fatality.METHODS: The ABC bundle was implemented from 1 June 2015 to 31 May 2016. Key process targets were set and a registry captured consecutive patients. We compared 30-day case fatality before, during and after bundle implementation with multivariable logistic regression and used mediation analysis to determine which care process measures mediated any association. Difference-in-difference analysis compared 30-day case fatality with 32,295 patients with ICH from 214 other hospitals in England and Wales using Sentinel Stroke National Audit Programme data.RESULTS: 973 ICH patients were admitted in the study period. Compared to before implementation, the adjusted odds of death by 30 days were lower in the implementation period (odds ratio [OR] 0·62; 95{\%} confidence interval [CI] 0·38 to 0·97; p=0·03) and this was sustained after implementation (OR 0·40; 95{\%}CI: 0·24 to 0·61; p<0·0001). Implementation of the bundle was associated with a 10·8 pp (95{\%}CI -17·9 to -3·7; p=0·003) reduction in 30-day case fatality in difference-in-difference analysis. The total effect of the care bundle was mediated by a reduction in do-not-resuscitate orders within 24 h (52·8{\%}) and increased admission to critical care (11·1{\%}).INTERPRETATION: Implementation of the ABC care bundle was significantly associated with lower 30-day case fatality after ICH. This article is protected by copyright. All rights reserved.",
author = "Parry-Jones, {Adrian R} and Camilla Sammut-Powell and Kyriaki Paroutoglou and Emily Birleson and Joshua Rowland and Stephanie Lee and Luca Cecchini and Mark Massyn and Richard Emsley and Benjamin Bray and Hiren Patel",
note = "This article is protected by copyright. All rights reserved.",
year = "2019",
month = "10",
day = "1",
doi = "10.1002/ana.25546",
language = "English",
volume = "86",
pages = "495--503",
journal = "Annals of Neurology",
issn = "0364-5134",
publisher = "John Wiley and Sons Inc.",
number = "4",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - An intracerebral hemorrhage care bundle is associated with lower case-fatality

AU - Parry-Jones, Adrian R

AU - Sammut-Powell, Camilla

AU - Paroutoglou, Kyriaki

AU - Birleson, Emily

AU - Rowland, Joshua

AU - Lee, Stephanie

AU - Cecchini, Luca

AU - Massyn, Mark

AU - Emsley, Richard

AU - Bray, Benjamin

AU - Patel, Hiren

N1 - This article is protected by copyright. All rights reserved.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - OBJECTIVE: Anticoagulation reversal, intensive blood pressure lowering, neurosurgery and access to critical care might all be beneficial in acute intracerebral hemorrhage (ICH). We combined and implemented these as the 'ABC' hyperacute care bundle and sought to determine whether the implementation was associated with lower case fatality.METHODS: The ABC bundle was implemented from 1 June 2015 to 31 May 2016. Key process targets were set and a registry captured consecutive patients. We compared 30-day case fatality before, during and after bundle implementation with multivariable logistic regression and used mediation analysis to determine which care process measures mediated any association. Difference-in-difference analysis compared 30-day case fatality with 32,295 patients with ICH from 214 other hospitals in England and Wales using Sentinel Stroke National Audit Programme data.RESULTS: 973 ICH patients were admitted in the study period. Compared to before implementation, the adjusted odds of death by 30 days were lower in the implementation period (odds ratio [OR] 0·62; 95% confidence interval [CI] 0·38 to 0·97; p=0·03) and this was sustained after implementation (OR 0·40; 95%CI: 0·24 to 0·61; p<0·0001). Implementation of the bundle was associated with a 10·8 pp (95%CI -17·9 to -3·7; p=0·003) reduction in 30-day case fatality in difference-in-difference analysis. The total effect of the care bundle was mediated by a reduction in do-not-resuscitate orders within 24 h (52·8%) and increased admission to critical care (11·1%).INTERPRETATION: Implementation of the ABC care bundle was significantly associated with lower 30-day case fatality after ICH. This article is protected by copyright. All rights reserved.

AB - OBJECTIVE: Anticoagulation reversal, intensive blood pressure lowering, neurosurgery and access to critical care might all be beneficial in acute intracerebral hemorrhage (ICH). We combined and implemented these as the 'ABC' hyperacute care bundle and sought to determine whether the implementation was associated with lower case fatality.METHODS: The ABC bundle was implemented from 1 June 2015 to 31 May 2016. Key process targets were set and a registry captured consecutive patients. We compared 30-day case fatality before, during and after bundle implementation with multivariable logistic regression and used mediation analysis to determine which care process measures mediated any association. Difference-in-difference analysis compared 30-day case fatality with 32,295 patients with ICH from 214 other hospitals in England and Wales using Sentinel Stroke National Audit Programme data.RESULTS: 973 ICH patients were admitted in the study period. Compared to before implementation, the adjusted odds of death by 30 days were lower in the implementation period (odds ratio [OR] 0·62; 95% confidence interval [CI] 0·38 to 0·97; p=0·03) and this was sustained after implementation (OR 0·40; 95%CI: 0·24 to 0·61; p<0·0001). Implementation of the bundle was associated with a 10·8 pp (95%CI -17·9 to -3·7; p=0·003) reduction in 30-day case fatality in difference-in-difference analysis. The total effect of the care bundle was mediated by a reduction in do-not-resuscitate orders within 24 h (52·8%) and increased admission to critical care (11·1%).INTERPRETATION: Implementation of the ABC care bundle was significantly associated with lower 30-day case fatality after ICH. This article is protected by copyright. All rights reserved.

UR - http://www.scopus.com/inward/record.url?scp=85070775659&partnerID=8YFLogxK

U2 - 10.1002/ana.25546

DO - 10.1002/ana.25546

M3 - Article

C2 - 31291031

VL - 86

SP - 495

EP - 503

JO - Annals of Neurology

JF - Annals of Neurology

SN - 0364-5134

IS - 4

ER -

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