ABSTRACT NUMBER: ESOC2026A1308 PRE- AND IN-HOSPITAL WORKFLOW TIMES FOR INTRACEREBRAL HEMORRHAGE IN THE GREATER AMSTERDAM REGION

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Abstract Background and aims Growing evidence shows that treatment of intracerebral hemorrhage (ICH) is highly time-sensitive, emphasizing the importance of rapid initiation of therapies such as reversal agents. To identify potential workflow improvements, we analyzed pre- and in-hospital time metrics for patients with ICH. Methods We linked data from the regional emergency medical service (EMS) to our institutional Stroke Database at Amsterdam UMC for all adult patients with spontaneous ICH presenting at our Emergency Department between 2017 and 2024. Workflow times for both pre- and intra-hospital phases were calculated. Results We included 399 patients with ICH. Median age was 72 years (IQR: 60-81), median NIHSS at arrival 13 (IQR: 6-21) and 63/399 patients (16%) received a reversal agent. In 379/399 cases (98%), the ambulance that transported the patient to the hospital was dispatched with the highest level of urgency. Time of onset was known in 120/399 cases (30%). Median onset-to-call time was 27 minutes (IQR: 11–102), call-to-hospital time 43 minutes (IQR: 36–52), and door-to-needle time (DNT) for anticoagulation reversal 64 minutes (IQR: 37–102). DNT exceeded 30, 60, and 90 minutes in 86%, 52%, and 27% of cases, respectively. Call-to-hospital times were similar for known versus unknown onset and for NIHSS 0–14 versus ≥15. Conclusions The majority of patients with ICH were presented to the hospital within one hour of EMS alert. In 52% of patients, reversal of anticoagulation was not initiated until more than one hour after hospital admission. These data may help to improve workflow times and thus optimize acute ICH management. Conflict of interest M.B.R.C.E., M.N.S., T.M., M.T., D.L. and M.I.B. have nothing to disclose, J.M.C. received unrelated research support from Bayer and related research support from AstraZeneca (all fees were paid to his employer), and is co-founder and shareholder of TrianecT. This study was funded by AstraZeneca. The funder had no role in the design of the study, the collection, analysis, and interpretation of data, or in writing this abstract.

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