Could implementing a goal-directed care bundle for lowering blood pressure improve outcomes for patients with intracerebral hemorrhage? TheLancet bloodpressure BP intracerebralhemorrhage stroke spontaneous acute
By Neha MathurMay 30 2023Reviewed by Lily Ramsey, LLM In a recent article published in the Lancet, researchers performed a multicentre, randomized controlled trial at hospitals in ten countries, of which nine were low- and middle-income countries and one was a high-income country, Chile.Study: The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial : an international, stepped wedge cluster randomised controlled trial.
Intracerebral hemorrhage is a type of stroke that is untreatable and accounts for ~20% of the 20 million stroke cases occurring worldwide every year, mostly in LMICs. The researchers used a modified Rankin Scale to measure improvement in functional outcomes six months post-treatment with the care bundle protocol vis-a-vis usual care. Scores between zero to one on the mRS indicate a favorable outcome, i.e., no disability; between two to five indicate increasing disability; and six indicate death.
The team randomly allocated three implementation sequences, each with four periods, to all participating hospitals, stratified by country and the estimated number of intracerebral hemorrhage patients it would admit during the study period of one year. It helped them assess the distribution in mRS scores, with adjustments for a cluster, e.g., hospital site, time using a proportional ordinal logistic regression model. It presented the standard odds of worse functional outcomes for the care bundle group than the usual care group.
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