Class I recommendations with level of evidence A or B for management of ICH
| Recommendation . | Class . | Level of evidence . |
|---|---|---|
| A baseline severity score should be performed as part of the initial evaluation of patients with ICH | I | B |
| Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH | I | A |
| Patients with ICH should have intermittent pneumatic compression for prevention of venous thromboembolism beginning the day of hospital admission | I | A |
| For ICH patients presenting with SBP between 150 and 220 mm Hg and without contraindication to acute BP treatment, acute lowering of SBP to 140 mm Hg is safe | I | A |
| Initial monitoring and management of ICH patients should take place in an intensive care unit or dedicated stroke unit with physician and nursing neuroscience acute care expertise | I | B |
| Clinical seizures should be treated with antiseizure drugs | I | A |
| A formal screening procedure for dysphagia should be performed in all patients before the initiation of oral intake to reduce the risk of pneumonia | I | B |
| Patients with cerebellar hemorrhage who are deteriorating neurologically or who have brainstem compression and/or hydrocephalus from ventricular obstruction should undergo surgical removal of the hemorrhage as soon as possible | I | B |
| BP should be controlled in all ICH patients. Measures to control BP should begin immediately after ICH onset | I | A |
| Given the potentially serious nature and complex pattern of evolving disability and the increasing evidence for efficacy, it is recommended that all patients with ICH have access to multidisciplinary rehabilitation | I | A |
| Recommendation . | Class . | Level of evidence . |
|---|---|---|
| A baseline severity score should be performed as part of the initial evaluation of patients with ICH | I | B |
| Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from ICH | I | A |
| Patients with ICH should have intermittent pneumatic compression for prevention of venous thromboembolism beginning the day of hospital admission | I | A |
| For ICH patients presenting with SBP between 150 and 220 mm Hg and without contraindication to acute BP treatment, acute lowering of SBP to 140 mm Hg is safe | I | A |
| Initial monitoring and management of ICH patients should take place in an intensive care unit or dedicated stroke unit with physician and nursing neuroscience acute care expertise | I | B |
| Clinical seizures should be treated with antiseizure drugs | I | A |
| A formal screening procedure for dysphagia should be performed in all patients before the initiation of oral intake to reduce the risk of pneumonia | I | B |
| Patients with cerebellar hemorrhage who are deteriorating neurologically or who have brainstem compression and/or hydrocephalus from ventricular obstruction should undergo surgical removal of the hemorrhage as soon as possible | I | B |
| BP should be controlled in all ICH patients. Measures to control BP should begin immediately after ICH onset | I | A |
| Given the potentially serious nature and complex pattern of evolving disability and the increasing evidence for efficacy, it is recommended that all patients with ICH have access to multidisciplinary rehabilitation | I | A |
Table adapted from Hemphill et al.27 Class I recommendations are for when there is evidence for and general agreement that the procedure or treatment is useful and effective. Level of evidence A is based on multiple randomized clinical trials or meta-analyses; level of evidence B is based on 1 randomized trial or observational studies.
BP, blood pressure; CT, computed tomography; ICH, intracranial hemorrhage; MRI, magnetic resonance imaging; SBP, systolic blood pressure.