The AHA/ASA 2010 guidelines recommend initial monitoring of intracerebral hemorrhage (ICH) patients in intensive care unit (ICU) or dedicated stroke unit. Consequently, per protocol all ICH patients regardless of characteristics of ICH are initially admitted to ICU for care which leads to consumption of resources that might be better utilized. We aimed to develop criteria to identify patients at low risk for hematoma expansion who do not need ICU care.

Chart review for patients admitted between July 2018 - Dec 2018 was performed. Age, sex, race, presenting Glasgow coma scale (GCS), ICH score, ICH volume, presence of IVH and location of the hemorrhage was documented. Patients who did not need any neurosurgical procedures (external ventricular drain or craniotomy) and were not documented to have respiratory failure on admission were further assessed for hematoma expansion to determine stability throughout hospital course.

118 patients with ICH were assessed, out of which 61 patients did not need any intervention or had respiratory failure on admission. On multivariate analysis these patients had GCS ≥ 13-15, ICH score ≥ 0-1 and no IVH. In this group of patients, only 9 patients had hematoma expansion documented on the repeat head imaging out of which 6 (67%) patients had coagulation abnormalities on admission either due to medications or low platelet count.

Based on GCS, ICH score and IVH, many patients could have been potentially admitted to dedicated stroke unit instead of ICU for further management. This would have led to decrease in ICU admission rate by 51% for all ICH patients. Patients who have documented coagulation abnormalities on admission should be monitored more closely due to high risk for hematoma expansion. Application of such separate protocol for dedicated stroke unit admission vs ICU admission would help in better utilization of resources.