Interpretation of Medical Quality Control Indicators for Intracerebral Hemorrhage

doi:10.3969/j.issn.1673-5765.2024.01.006

Abstract

Abstract: The incidence of intracerebral hemorrhage (ICH) is less than ischemic stroke, but its mortality and disability rate are high. In China, nearly 46% of patients with ICH died or left serious disability within one year. Therefore, it is particularly important to standardize the diagnosis and treatment of ICH. In 2018, the American Heart Association (AHA) /American Stroke Association (ASA) developed clinical management indicators for patients with ICH based on the higher level of evidence level Ⅰ or Ⅲ recommendations in the guidelines for the management of spontaneous ICH, translating the guidelines into clinically practical quantitative indicators. From July 2021, the National Center for Healthcare Quality Management in Neurological Diseases and the Management and Improvement of Chinese Medical Care Quality on Stroke, Chinese Stroke Association adopted the improved Delphi method and finally formulated an index system for medical quality control of ICH, including 11 indicators. This paper makes detailed interpretation of these 11 indicators in order to guide medical institutions to provide medical assistance for patients in the best time safely and effectively, improve the quality of medical assistance for patients with ICH, and improve the clinical outcome of patients.

Key words: Intracerebral hemorrhage; Quality control; Blood pressure; Anticoagulation therapy; Imaging examination; Rehabilitation

摘要： 脑出血的发病率低于脑梗死，但致死率和致残率高，在我国，约46％的脑出血患者在发病1年内死亡或遗留严重残疾，因此规范脑出血的诊疗就显得尤为重要。2018年，美国心脏学会（American Heart Association，AHA）/美国卒中学会（American Stroke Association，ASA）根据其发布的自发性脑出血管理指南中证据级别较高的Ⅰ类或Ⅲ类推荐意见，制定了脑出血患者的临床管理指标，将指南转化为临床可实践的量化指标。从2021年7月开始，我国国家神经系统疾病医疗质量控制中心联合中国卒中学会医疗质量管理与促进分会，采用改良德尔菲法，最终制定了包括11项指标的脑出血医疗质量控制指标体系。本文对这11项指标进行具体解读，以期指导医疗机构在最佳时间内安全、有效地为患者提供医疗救护，提高脑出血患者的医疗救护质量，从而改善患者的临床转归。

关键词: 脑出血; 质量控制; 血压; 抗凝治疗; 影像学检查; 康复

CLC Number:

WANG Jing, LI Zixiao, DONG Qiang, ZHAO Xingquan. Interpretation of Medical Quality Control Indicators for Intracerebral Hemorrhage[J]. Chinese Journal of Stroke, 2024, 19(1): 50-54.

王晶, 李子孝, 董强, 赵性泉. 《脑出血医疗质量控制指标》的解读[J]. 中国卒中杂志, 2024, 19(1): 50-54.

References

[1] 张谦，冀瑞俊，赵萌，等. 中国脑血管病临床管理指南（第2版）（节选）——第5章脑出血临床管理[J]. 中国卒中杂志，2023，18（9）：1014-1023.
ZHANG Q，JI R J，ZHAO M，et al. Chinese stroke association guidelines for clinical management of cerebrovascular diseases（second edition）（excerpt）—chapter five clinical management of intracerebral hemorrhage[J]. Chin J Stroke，2023，18（9）：1014-1023.
[2] GBD 2019 Stroke Collaborators. Global，regional，and national burden of stroke and its risk factors，1990—2019：a systematic analysis for the global burden of disease study 2019[J]. Lancet Neurol，2021，20（10）：795-820.
[3] WANG W Z，JIANG B，SUN H X，et al. Prevalence，incidence，and mortality of stroke in China：results from a nationwide population-based survey of 480 687 adults[J]. Circulation，2017，135（8）：759-771.
[4] HEMPHILL J C，ADEOYE O M，ALEXANDER D N，et al. Clinical performance measures for adults hospitalized with intracerebral hemorrhage：performance measures for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2018，49（7）：e243-e261[2023-12-09]. https://doi.org/10.1161/str.0000000000000171.
[5] CHEUNG R T，ZOU L Y. Use of the original，modified，or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage[J]. Stroke，2003，34（7）：1717-1722.
[6] HEMPHILL J C，BONOVICH D C，BESMERTIS L，et al. The ICH score：a simple，reliable grading scale for intracerebral hemorrhage[J]. Stroke，2001，32（4）：891-897.
[7] GREENBERG S M，ZIAI W C，CORDONNIER C，
et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage：a guideline from the American Heart Association/American Stroke Association[J/OL]. Stroke，2022，53（7）：e282-e361[2023-12-09]. https://doi.org/10.1161/str.0000000000000407.
[8] MOULLAALI T J，WANG X，MARTIN R H，et al. Blood pressure control and clinical outcomes in acute intracerebral haemorrhage：a preplanned pooled analysis of individual participant data[J]. Lancet Neurol，2019，18（9）：857-864.
[9] ANDERSON C S，HEELEY E，HUANG Y，et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage[J]. N Eng J Med，2013，368（25）：2355-2365.
[10] QURESHI A I，PALESCH Y Y，BARSAN W G，et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage[J]. N Eng J Med，2016，375（11）：1033-1043.
[11] O’DONNELL M J，XAVIER D，LIU L S，et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries（the INTERSTROKE study）：a case-control study[J]. Lancet，2010，376（9735）：112-123.
[12] CHAPMAN N，HUXLEY R，ANDERSON C，et al. Effects of a perindopril-based blood pressure-lowering regimen on the risk of recurrent stroke according to stroke subtype and medical history：the PROGRESS trial[J]. Stroke，2004，35（1）：116-121.
[13] PEACOCK W F，GEARHART M M，MILLS R M. Emergency management of bleeding associated with old and new oral anticoagulants[J]. Clin Cardiol，2012，35（12）：730-737.
[14] GIBLER W B，RACADIO J M，HIRSCH A L，et al. Management of severe bleeding in patients treated with oral anticoagulants：proceedings monograph from the emergency medicine cardiac research and education group-international multidisciplinary severe bleeding consensus panel october 20，2018[J]. Criti Pathw Cardiol，2019，18（3）：143-166.
[15] DAVIS S M，BRODERICK J，HENNERICI M，et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage[J]. Neurology，2006，66（8）：1175-1181.
[16] DELCOURT C，HUANG Y，ARIMA H，et al. Hematoma growth and outcomes in intracerebral hemorrhage：the INTERACT 1 study[J]. Neurology，2012，79（4）：314-319.
[17] LI Q，ZHANG G，HUANG Y J，et al. Blend sign on computed tomography：novel and reliable predictor for early hematoma growth in patients with intracerebral hemorrhage[J]. Stroke，2015，46（8）：2119-2123.
[18] LI Q，ZHANG G，XIONG X，et al. Black hole sign：novel imaging marker that predicts hematoma growth in patients with intracerebral hemorrhage[J]. Stroke，2016，47（7）：1777-1781.
[19] LI Q，LIU Q J，YANG W S，et al. Island sign：an imaging predictor for early hematoma expansion and poor outcome in patients with intracerebral hemorrhage[J]. Stroke，2017，48（11）：3019-3025.
[20] CAO D，LI Q，FU P，et al. Early hematoma enlargement in primary intracerebral hemorrhage[J]. Curr Drug Targets，2017，18（12）：1345-1348.
[21] JI R J，SHEN H P，PAN Y S，et al. Risk score to predict hospital-acquired pneumonia after spontaneous intracerebral hemorrhage[J]. Stroke，2014，45（9）：2620-2628.
[22] 王拥军，陈玉国，吕传柱，等. 卒中相关性肺炎诊治中国专家共识（2019更新版）[J]. 中国卒中杂志，2019，14（12）：1251-1262.
WANG Y J，CHEN Y G，LYU C Z，et al. An updated Chinese consensus statement on stroke-associated pneumonia 2019[J]. Chin J Stroke，2019，14（12）：1251-1262.
[23] HOFFMANN S，HARMS H，ULM L，et al. Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia—the PREDICT study[J]. J Cereb Blood Flow Metab，2017，37（12）：3671-3682.
[24] STEIN J，KATZ D I，BLACK SCHAFFER R M，et al. Clinical performance measures for stroke rehabilitation：performance measures from the American Heart Association/American Stroke Association[J/OL]. Stroke，2021，52（10）：e675-e700[2023-12-10]. https://doi.org/10.1161/str.0000000000000388.