Optimising the haemostasis of patients with intracranial haemorrhage
Abstract
Aim:
Optimising the management of older patients admitted with intracranial haemorrhage (ICH) to a District General Hospital.
Methodology:
This retrospective quality improvement project included patients >65 years old admitted with ICH under the general surgical team over a six-month period (01/01/2025-01/07/2025).
Data was collected from the electronic health record (Cerner) and outcomes were analysed. Data will be presented as median (range) unless stated otherwise. Statistical analysis conducted on GraphPad Prism.
Results:
62 patients were included, aged 84 (65-99) years. Thirty-three patients (53%) had a clinical frailty score (CFS) >=4. The average length of stay (LOS) was 8 (1-39) days. 99% of patients (n=61) were discussed with the neurosurgery centre, sixteen required re-discussion, and three were transferred. No patients required ICU admission.
Twenty-eight patients (46%) were anticoagulated, predominantly on direct oral anticoagulants (n=24, 85.7%): twenty-three (82%) had atrial fibrillation, two had venous thromboembolism, two had metallic heart valves. Eight patients were discussed with haematology. Twenty patients received Beriplex for reversal, seven had Vitamin K. Five patients had Tranexamic acid. Five patients had haemorrhagic progression on repeat CT, all had been on anticoagulants.
Sixteen patients had DNACPR forms, and twelve patients had documented escalation plans. 71% (n=44) patients received physiotherapy and occupational therapy input.
Forty-seven patients (75%) were discharged to the same residence, five required in-patient rehabilitation, two needed neurological rehabilitation. Five patients died, of these, four had been on anticoagulation, which was reversed. The deceased patients were 84 (77-95) years old with a CFS of 4.
Conclusion:
Frail elderly patients with complex co-morbidities experienced longer LOS and higher mortality rates. Establishing a ‘Head injury pathway’ will optimise patient care.