Abstract T P179: Guideline Adherence in Testing for Drugs of Abuse in Intracerebral Hemorrhage

Introduction: Sympathomimetic drugs have been associated with poorer outcomes in intracerebral hemorrhage (ICH). The ICH guidelines recommend screening young and middle-aged patients for drugs of abuse but guideline adherence data are scarce, particularly outside of academic centers. We sought to characterize the pattern of testing for drugs of abuse in a cohort of primary ICH patients at a large academic referral center. Methods: We performed a retrospective study of primary ICH occurring in 2009. Cases were identified by ICD-9 code and verified by physician review. Demographic data, vascular risk factors, imaging characteristics, processes of care, and short-term outcomes were ascertained. We analyzed performance of urine drug screen (UDS) by race, sex, age, and hospital presentation (outside hospital [OSH] vs. academic center). Results: We identified 131 patients with primary ICH in 2009; 100 (76.3%) were initially evaluated at an OSH. Cohort characteristics are in the Table. Overall, 19 (14.5%) patients had UDS performed at either the OSH or the academic center, with no positive screens for either cocaine or amphetamine. There was no difference in testing between men and women (10/67 vs. 9/64, p=0.89). Of patients Conclusions: We found suboptimal guideline adherence for drugs of abuse testing in our ICH cohort. Systematic efforts to improve guideline adherence in a variety of acute care settings are warranted. Improved identification of sympathomimetic exposure may improve etiologic classification and could influence both therapeutic decision-making and prognosis counseling.