Predicting the Likelihood of Neurosurgical Intervention Prior to Transfer of Spontaneous Intracerebral Hemorrhage (ICH) to Tertiary Care Facilities Using Data From a Retrospective Cohort: The Likelihood of Neurosurgery Score (LoNS).
Document Type
Article
Publication Date
10-28-2025
Institution/Department
Neurology; Center for Clinical and Translational Science
Journal Title
Neurohospitalist
Abstract
BACKGROUND: Patients with spontaneous intracranial hemorrhage (ICH) who present to non-tertiary care centers are often transferred to a facility with neurosurgical expertise without consideration of the likelihood of surgical intervention. At our Comprehensive Stroke Center (CSC), a minority of patients transferred for neurosurgical evaluation undergo interventions putting a strain on hospital resources. This study aimed to (1) quantify the frequency of neurosurgical intervention in ICH patients transferred to our hospital and, (2) to develop a tool to aid in transfer decisions.
METHODS: Using an IRB-approved retrospective cohort study design, we identified all spontaneous ICH patients transferred to our CSC between January 1, 2016, and May 31, 2023. All patients were reviewed to ensure a primary diagnosis of non-traumatic supratentorial ICH. Odds ratios were calculated using a logistic regression model to identify factors predictive of neurosurgery which were weighted by strength of association. Internal validation was then performed.
RESULTS: Of the 496 participants included in the final dataset, 78 (15.7%) underwent neurosurgical intervention. Age, Glasgow Coma Scale, ICH volume, and intraventricular extension were the greatest predictors of neurosurgery. These factors were used to create the Likelihood of Neurosurgery Score (LoNS), a weighted score used to inform transfer decisions. The score performed well on calibration and discrimination tests.
CONCLUSION: The LoNS is a new tool to identify ICH patients unlikely to be neurosurgical candidates who could be safely managed at the local level rather than urgently transferred to a tertiary care center. Prospective validation is needed.
ISSN
1941-8744
First Page
19418744251393352
Last Page
19418744251393352
Recommended Citation
Morris, Jane; Barry, Samantha; Sawyer, Jared; Birkbeck, Duncan; Craig, Wendy Y; and Puissant, Madeleine M, "Predicting the Likelihood of Neurosurgical Intervention Prior to Transfer of Spontaneous Intracerebral Hemorrhage (ICH) to Tertiary Care Facilities Using Data From a Retrospective Cohort: The Likelihood of Neurosurgery Score (LoNS)." (2025). MaineHealth Maine Medical Center. 4274.
https://knowledgeconnection.mainehealth.org/mmc/4274
