International beliefs and head positioning practices in patients with spontaneous hyperacute intracerebral hemorrhage

Wendy Dusenbury; Marc D Malkoff; Peter D Schellinger; Martin Köhrmann; Adam S Arthur; Lucas Elijovich; Andrei V Alexandrov; Georgios Tsivgoulis; Anne W Alexandrov

doi:10.1177/17562864231161162

International beliefs and head positioning practices in patients with spontaneous hyperacute intracerebral hemorrhage

Ther Adv Neurol Disord. 2023 Mar 24:16:17562864231161162. doi: 10.1177/17562864231161162. eCollection 2023.

Authors

Wendy Dusenbury¹, Marc D Malkoff², Peter D Schellinger³, Martin Köhrmann⁴, Adam S Arthur^{2

5}, Lucas Elijovich^{2

5}, Andrei V Alexandrov^{2

6}, Georgios Tsivgoulis^{7

2}, Anne W Alexandrov²

Affiliations

¹ University of Tennessee Health Science Center, Memphis, TN 38163, USA.
² University of Tennessee Health Science Center, Memphis, TN, USA.
³ John Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany.
⁴ University Dulsury-Essen, Essen, Germany.
⁵ Semmes-Murphey Neurosurgery, Memphis, TN, USA.
⁶ Banner University Hospital, University of Arizona College of Medicine, Phoenix, AZ.
⁷ National and Kapodistrian University of Athens, Athens, Greece.

Abstract

Background: Prior to the conduct of the Head Position in Stroke Trial (HeadPoST), an international survey (n = 128) revealed equipoise for selection of head position in acute ischemic stroke.

Objectives: We aimed to determine whether equipoise exists for head position in spontaneous hyperacute intracerebral hemorrhage (ICH) patients following HeadPoST.

Design: This is an international, web-distributed survey focused on head positioning in hyperacute ICH patients.

Methods: A survey was constructed to examine clinicians' beliefs and practices associated with head positioning of hyperacute ICH patients. Survey items were developed with content experts, piloted, and then refined before distributing through stroke listservs, social media, and purposive snowball sampling. Data were analyzed using descriptive statistics and χ² test.

Results: We received 181 responses representing 13 countries on four continents: 38% advanced practice providers, 32% bedside nurses, and 30% physicians; overall, participants had median 7 [interquartile range (IQR) = 3-12] years stroke experience with a median of 100 (IQR = 37.5-200) ICH admissions managed annually. Participants disagreed that HeadPoST provided 'definitive evidence' for head position in ICH and agreed that their 'written admission orders include 30-degree head positioning', with 54% citing hospital policies for this head position in hyperacute ICH. Participants were unsure whether head positioning alone could influence ICH longitudinal outcomes. Use of serial proximal clinical and technology measures during the head positioning intervention were identified by 82% as the most appropriate endpoints for future ICH head positioning trials.

Conclusion: Interdisciplinary providers remain unconvinced by HeadPoST results that head position does not matter in hyperacute ICH. Future trials examining the proximal effects of head positioning on clinical stability in hyperacute ICH are warranted.

Keywords: head of bed position; intracerebral hemorrhage; intracranial pressure.