ABSTRACT NUMBER: ESOC2026A1592 EMERGENCY DEPARTMENT TRANSFER AND INTERVENTION THRESHOLDS FOR PATIENTS WITH ACUTE INTERCEREBRAL HEMORRHAGE IN A HEALTH SYSTEM WITH TELENEUROCRITICAL CARE

Abstract Background and aims Transferring patients with a spontaneous intracerebral hemorrhage (ICH) to a comprehensive stroke center (CSC) with subspecialized neurological care is routine. However, not all patients require such care, and existing thresholds for transferring do not factor in the role of Teleneurocritical Care (TeleNCC). We aim to identify (1) predictors of neurosurgical or neurointerventional interventions within a system covered by TeleNCC, and (2) improve thresholds for transferring. Methods Patients ≥ 18 years old with an ICH admitted or transferred to a primary stroke center (PSC) or CSC between1/1/2022–7/1/2025 were included. Patients were grouped by PSC versus CSC, and then secondarily if utilized a highest-level in-person only neurological intervention. ROC curve and logistic regression were performed using clinical variables: age, NIHSS, ICH score, anticoagulation, ICH location, intraventricular hemorrhage, and total hemorrhage volume. Results A total of 212 patients were included, 24.5% received highest-level neurological interventions, and there was no difference in intervention rate nor mortality between PSC and CSC. Four variables were significant in logistic regression to require an intervention: age (OR 0.956/1 yr, 95% CI: 0.933-0.979), basal ganglia location (OR 0.398, 95% CI: 0.178-0.893), and IVH and ICH volume (OR 9.322, 95% CI: 2.43-35.81; OR 1.013, 95% CI 1.001-1.025, respectively). In the final classification table there was 94.9% accuracy to predict absence of intervention (Hosmer-Lemeshow Chi-square 9.3, p=0.437). Conclusions In patients with an ICH presenting to the ED in a system covered by TeleNCC, four variables could inform thresholds for non-transfer or transferring patients to a PSC with TeleNCC, rather defaulting to a CSC. Conflict of interest All authors nothing to disclose