Medical and socioeconomic factors may impact decisions to change the goals of care for patients with intracerebral hemorrhage (ICH) to comfort measures only, according to a recent study. Furthermore, black patients were 76% less likely to withdraw life support than white patients. Therefore, providers should be aware of potential racial disparities. Researchers reviewed prospectively collected data on patients with ICH, including baseline patient demographics, Glasgow Coma Scale (GCS), National Institute of Health Stroke Scale (NIHSS), and ICH score. They found:
- Of 198 patients included in the analysis, 39 (19.7%) were made comfort measures only.
- Age, gender, insurance status, substance use, and medical comorbidities were similar between groups.
- Race was significantly different between the comfort measures only (black 15.4%, white 51.3%, other 33.3%) and noncomfort measures only groups (black 39.6%, white 45.9%, other 14.5%).
- Patients changed to comfort measures only had higher mean income based on zip code ($59,264 vs $49,916), higher median NIHSS (23 vs 16), higher ICH score (2.7 vs 1.5), lower median GCS (7 vs 13).
- Mortality, poor outcome, and hospital length of stay were not significantly different between black and white patients.
Fraser SM, Torres GL, Cai C, Choi HA, Sharrief A, Chang TR. Race is a predictor of withdrawal of life support in patients with intracerebral hemorrhage. [Published online ahead of print August 16, 2018]. J Stroke Cerebrovasc. doi:10.1016/j.jstrokecerebrovasdis.2018.07.006.