The Influence of Direct Transportation to Neurosurgical-Capable Medical Centers on Clinical Outcomes of Patients with Spontaneous Intracerebral Hemorrhage in Urban Area: A Two-center Retrospective Study

Zijian Chen¹Haibo Li²Zhaodi Liao²Xuexiang Shen¹Peizhi Qin¹Wei Ji²YUANRUN ZHU^2*

• ¹Zhejiang Chinese Medical University, Hangzhou, China
• ²Wuxi People's Hospital, Wuxi, China

Spontaneous intracranial haemorrhage (ICH) is one of the major causes of morbidity and mortality worldwide due to its poor clinical outcome. Recent guidelines recommended transfer to medical centers with neurosurgical capabilities to improve outcomes, but whether centers that do not have neurosurgical capabilities should be bypassed was not determined. The current study analyzed the effect of direct transportation to neurosurgical-capable centers among patients with spontaneous ICH in the urban area of Southeast China. We included 143 adult patients with spontaneous ICH admitted to two neurosurgical-capable centers from Jan 2022 to Dec 2024. A total of 33 were transferred from local centers without neurosurgical capabilities and 110 were admitted directly. The patients had similar baseline characteristics and initial status upon admission. Patients transferred from local centers had a shorter time interval between Emergency Medical Service (EMS) initiation and first computed tomography (CT) scan (0.9 ± 0.3 hours vs. 1.7 ± 0.6 hours, p < 0.001) but a longer time interval before arriving at neurosurgical-capable center (1.6 ± 0.4 hours vs. 1.4 ± 0.6 hours, p = 0.047). Clinical outcomes, including in-hospital mortality and Glasgow Outcome Scale (GOS) score upon discharge, indicated no statistical difference between the groups, whether the patients underwent neurosurgical operations or not. In conclusion, the strategy of direct transportation to neurosurgical-capable centers in urban areas did not improve clinical outcomes among patients with ICH, and transfer from local centers after primary diagnosis might be an acceptable strategy.