**4. Discussion**

In our study we found several similarities with many papers about ICH. In our series the mean age of the patients was 66 years old. The same was reported by Hemphill et al. (66 ± 15 years) but is higher than the age reported by Lavados et al. in the PISCIS Study (57.3 ± 17 years) [13, 31]. This difference could be explained because we used a convenience sample with cases that were not included consecutively. In our series we included about 1/6 of the ICH cases diagnosed in the ER of HHHA (about 220 cases/year). On the other hand, the locations found were similar to the findings of Hemphill et al.: 81.5%


#### **Table 3.**

*Radiological characteristics of patients with intracerebral hemorrhage Hospital Dr. Hernán Henríquez Aravena, Temuco, Chile, in 2016–2018.*

supratentorial and 15.5% infratentorial [31]. We also found a 70.4% of the cases due to hypertension as the presumed cause. This is similar to the Hemphill study but higher than what was reported in the PISCIS Study [13, 31]. This difference in the results in comparison with our study can be explained because in the PISCIS Study, the patients were younger.

We found a 30-day mortality of 30.6% which is lower than the mortality reported by Hemphill in 2001 (45%) and similar to the 28.9% reported in Iquique, Chile [11, 31]. We also found a 6-month mortality of 37.0% which is similar to the 39% found in the PISCIS Study [11].

Unlike what was reported by Hemphill who found an association between mortality and age over 80 years, we found an association with age 65+ years (p = 0.091) [31]. In this sense we consider useful the modification in the ICH score proposed by Hegde et al. by reducing the age criteria by 10 years to prognosticate the disease better in populations belonging to developing countries like Chile [36].

Only 39.8% of our patients were admitted in the ICU. This reality is completely contrary to the clinical recommendations in developed countries. For instance, the American guideline for ICH management states that the 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 (Class I; Level of Evidence B) [37]. We can suppose that many patients die because they do not receive the care that the severity of their illness requires.

When presenting our results, we must emphasize that the HHHA does not have a specific infrastructure to attend to neurological patients, that is, a stroke unit. These units have demonstrated their cost-effectiveness in decreasing mortality and disability due to stroke [38]. In our situation, not all ICH patients are admitted to the ICU and complete 24–48 h of observation in the ER, being later hospitalized at the internal medicine service.

About 80% of the population in Chile is treated in the public health system [21]. Users of the public system have worse health indicators than users of the private health system [9]. On the other hand, it is expected that the incidence of ICH will

**55**

*Epidemiology and Management of Intracerebral Hemorrhage in Chile*

increase significantly in our country due to the aging of the population and the poor control of cerebrovascular risk factors. This is why we see the need to have a stroke unit and/or a neurologic intermediate care unit in our hospital for the adequate management of patients with ICH. We also hope to set a Telestroke system with the future primary stroke centers in our region (Nueva Imperial, Pitrufquén, Lautaro, Villarrica, Victoria, and Angol hospitals). In short, we hope that the HHHA will become a comprehensive stroke center [39]. We also consider a priority to develop a better access in the detection and treatment of all the vascular risk factors mainly the control of hypertension. In the NHS 2003 in Chile, only 60% of the hypertensive knew their condition, 33% were being treated, and only 30% had normal

ICH is a common cause of consultation in our hospital, especially in older people. The implementation of 24/7 neurology shifts in the emergency room allowed us to reduce the evaluation time and to improve the management of ICH patients; however, it is still difficult to admit ICH patients to the ICU. We are aiming for a soon implementation of a stroke unit, so ICH patients receive a standardized care. It's a main priority to have better access to primary care prevention, diagnosis,

*DOI: http://dx.doi.org/10.5772/intechopen.86312*

and treatment in developing countries like ours.

This study is funded by the Universidad de La Frontera.

values [40].

**5. Conclusion**

**Acknowledgements**

**Conflict of interest**

None.

*Epidemiology and Management of Intracerebral Hemorrhage in Chile DOI: http://dx.doi.org/10.5772/intechopen.86312*

increase significantly in our country due to the aging of the population and the poor control of cerebrovascular risk factors. This is why we see the need to have a stroke unit and/or a neurologic intermediate care unit in our hospital for the adequate management of patients with ICH. We also hope to set a Telestroke system with the future primary stroke centers in our region (Nueva Imperial, Pitrufquén, Lautaro, Villarrica, Victoria, and Angol hospitals). In short, we hope that the HHHA will become a comprehensive stroke center [39]. We also consider a priority to develop a better access in the detection and treatment of all the vascular risk factors mainly the control of hypertension. In the NHS 2003 in Chile, only 60% of the hypertensive knew their condition, 33% were being treated, and only 30% had normal values [40].
