Intracerebral hemorrhage specific intensity of care quality metrics

Adnan I. Qureshi

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations


Background: Intracerebral hemorrhage (ICH) care can vary among centers and previous studies have demonstrated differences in ICH outcome based on variations in patient care in various settings. The purpose of this paper is to present the design of an evidence-based dataset of elements of a new ICH specific intensity of care quality metrics. Methods: The articles were identified based on personal knowledge of the subject supplemented by data derived from multi-center randomized trials, and selected non-randomized or observational clinical studies. The information was identified with multiple searches on MEDLINE from 1986 through 2009. The current guidelines from American Heart Association (AHA)/American Stroke Association (ASA) Stroke Council and The European Stroke Initiative (EUSI) Writing Committee for management of ICH were reviewed extensively for identifying quality indicators and available scientific evidence. For certain elements where stroke-specific data was not available, data derived from other disease process with direct relevance was used. Results: A total of 26 quality indicators related to 18 facets of care with thresholds for quality response were identified.A pilot study was performed to asses and score 1300 (26 indicator per patientX25 patientsX2 raters) quality indicators. The minimum proportion of patients meeting quality parameter ranged from 44% to 100% depending upon the variable. The lowest performance scores were observed in the early intubation and mechanical ventilation, treatment of significant intracranial mass effect or transtentorial herniation, and timely acquisition of neuroimaging. The highest performance scores were seen in treatment of any seizure within 2 weeks of admission, status epilepticus, and prevention of gastric ulcer. Conclusions: The next step in development of a new ICH specific intensity of care quality metrics is validation and refinement of the quality indicators and thresholds presented in the current report. Future activities may include selection and validation based on consensus of experts and application of the system to a large series of patients with ICH and assessment of relationship of components in isolation and as a group to outcome after severity adjustment.

Original languageEnglish (US)
Pages (from-to)291-317
Number of pages27
JournalNeurocritical Care
Issue number2
StatePublished - Apr 2011

Bibliographical note

Funding Information:
Acknowledgment I thank Nauman Tariq, M.D., and Musthaq H. Qureshi, M.D., for assistance with this study, and Gabriela Vazquez PhD for her assistance in the statistical analysis. Dr. Qureshi has received funding from National Institutes of Health RO-1-NS44976-01A2 (medication provided by ESP Pharma), U-01-NS062091 medication provided by ESP Pharma), American Heart Association Established Investigator Award 0840053N, and Minnesota Medical Foundation, Minneapolis, MN.


  • Cerebral hemorrhage
  • Intensity of care
  • Intensive care unit
  • Intracerebral hemorrhage
  • Quality indicators


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