Introduction: Intracerebral hemorrhage (ICH) is a cause of high mortality with scope for targeted utilization of hospice and palliative care services. This study investigates patient characteristics and outcomes of discharge disposition and length of stay (LOS) in the context of clinical severity as described by ICH score. Methods: Patients presenting to a comprehensive stroke center from 2019 to 2023 with discharge diagnosis of ICH and documented ICH score were included. Retrospective data was extracted from the institution’s research data warehouse and analysis conducted using R version 3.5.1 for Windows. Statistical tests used were the Kruskal-Wallis test to compare LOS, defined as the difference between hospital arrival and discharge times, and Fisher’s exact test for counts. Results: A total of 703 patients were included. The number of patients with each ICH score and demographics are described in Table 1, with risk factors and treatment settings in Table 2. Mortality was 15.4% (n=108), 27.9% (196) discharged to home, 46.2% (325) other (skilled nursing or rehabilitation) facility, 7.3% (51) hospice facility, 1.6% (11) home hospice, 1% (7) acute care, and 0.7% (5) left against medical advice (AMA) or disposition was unclear. Mean LOS was 9.9 days overall and for each disposition as follows, statistically different per Kruskal-Wallis test (p<0.00, chi-squared=192.7): home 5.1, other facility 13.3, hospice facility 8.0, home hospice 16.2, acute care 19.9, AMA or unknown 5.2, and expired 8.0. Mean LOS and disposition for each ICH score are in Table 3, with statistically significant differences per Kruskal-Wallis test for LOS (p<0.00, chi-squared=76.6) and Fisher’s exact test for disposition (p<0.00). Conclusions: In-hospital mortality exceeded discharge to hospice facility and home hospice combined for patients with ICH scores 2 and above. Home hospice utilization was especially low among only 11 patients across 5 years, with LOS of 16 days which is double that of hospice facility. Mean LOS was longest at 2 weeks for patients with ICH score of 2 or 3, and those with score 4 had 58% mortality with mean LOS 10.5 days. These results imply that the ICH score can serve not only to grade severity but also to trigger timely palliative care consultation. Incorporating structured pathways that link ICH severity to early palliative and hospice involvement may shorten hospital stays, support informed decision-making, and improve patient- and family-centered outcomes.
Lingam et al. (Thu,) studied this question.