355 Anti-Coagulant, Anti-Platelet Use in Intra-Cerebral Hemorrhage Patients: Does Reversal of International Normalized Ratio Translate to Improved Outcome? Jain A, Bellolio M, Palamari B, Odufuye AO, Dhillon RK, Manivannan V, Gilmore RM, Decker WW, Stead LG/University of Rochester, Rochester, NY; Mayo Clinic, Rochester, MN Study Objectives: To assess the impact of anticoagulants and antiplatelet agents on the severity and outcome of spontaneous nontraumatic intracerebral hemorrhage (ICH). To report agents used for reversal and its’ bearing on mortality and morbidity in these patients. Methods: Consecutive cohort of adults presenting with ICH to an academic emergency department over a 3-year period starting Jan/06. Patients with a recurrent episode of intra-cerebral hemorrhage during the study period were excluded. Data on demographics, current and past medical history, coagulation parameters, CT scan findings, stroke severity at presentation, functional outcome at discharge and time of death were collected and analyzed using JMP 8.0. Results: The final cohort of 245 patients consisted of 125 females (51.1%) with median age of 73 years [inter-quartile (IQR) range of 59 – 82 years]. Antiplatelet (AP) use was seen in 32.6%, 18.4% were using Anti-coagulant (AC) use in 18.4% and 8.9% patients were on both drugs (AC+AP). Patients on AC had significantly higher international normalized ratio (INR) (median 2.3) and aPTT (median 31 sec) when compared to patients not on AP/AC (median INR 1.0, median aPTT 24 sec. Similarly patients on AC+AP also had higher INR (median 1.9) and aPTT (median 30 sec) when compared to those not on AC/AP (p0.001). Patients on AP alone had normal INR and aPTT. The volume of hemorrhage was significantly higher for patients on AC alone (median 64.7cc) when compared to those not on either AC/AP (median 27.2cc; p=0.05). The same was not found for patients using AP (median volume 20.5cc; p=0.813), or both AC+AP (median volume 27.7cc; p=0.619). Patients on AC had a relative risk (RR) of 1.43 (95% CI 1.04 to 1.98) to have an intraventricular extension as compared to patients not on AC/AP (p=0.035). The median NIHSS score on arrival was 8 (IQR 2 to 20). There was no relationship between the NIHSS score and use of AC/AP/AC+AP (p=0.57). There was no relationship between use of AC (p=0.094), AP (p=0.604), AC+AP (p=0.156) and bad functional outcome (modified Rankin score 2). Patients on AC had a relative risk of 1.74 (95% CI 1.0 to 3.03, p=0.05) for 7-day mortality, when compared to patients using neither AC/AP. No relationship was found between use of AP or AC+AP use and mortality. Of the 82 patients with INR 1.0, 52 patients were given reversal (minimum INR 1.4, median 2.3). Of these patients 86.5% received fresh frozen plasma (median dose 4U), 82.7% received Vitamin K (median dose 10mg), 30.7% patients received recombinant factor VIIa (median dose 3600 mcg), and 5.8% received platelets. Post reversal the median INR was 1.25 (IQR 1–1.5), and it decreased to 1.2 (IQR 1.1–1.3) at 24 hours. There was no association between reversal and volume of hemorrhage, intraventricular extension, early mortality (death7 days) or functional outcome. Conclusions: Anticoagulated patients were at 1.7 times at higher risk of early mortality after ICH. Reversal of INR to normal did not influence mortality or functional outcome. 356 Do Not Resuscitate Orders in Spontaneous Non- Traumatic Intra-Cerebral Hemorrhage: What Is the Difference? Jain A, Bellolio M, Odufuye AO, Dhillon RK, Manivannan V, Yerragondu N, Palamari B, Gilmore RM, Decker WW, Stead LG/University of Rochester, Rochester, NY; Mayo Clinic, Rochester, MN Study Objectives: To describe characteristics and outcomes of patients with Do not resuscitate/do not intubate/comfort care (DNR/DNI/CC) orders in a cohort of patients with acute spontaneous intra-cerebral hemorrhage (ICH). Methods: A consecutive cohort of patients diagnosed with ICH in an academic emergency department (ED). The time of institution of DNR/DNI/CC orders was collected from medical records. Results: In the final cohort of 245 patients, 55 patients had DNR/DNI and 43 had CC orders instituted. Of these 98 patients, 94 had DNR/DNI/CC orders initiated during this hospital admission. Of these, 53.1% died within the first 7 days of the ICH compared to 6.1% without DNR/DNI/CC orders (RR 8.7, p0.0001), and 63.3% died within 30 days (RR 7.1, p0.0001) when compared to patients without DNR/DNI/CC orders. Patients who had DNR/DNI/CC orders were significantly older (median age 81; IQR 70 to 86 years) than patients who did not have these orders (median age 67; IQR 55 to 78 years; p 0.0001). Females were 1.7 times more likely to have DNR/ DNI/CC orders initiated than males. Past medical history of major cardiovascular risk factors had no relation with institution of DNR/DNI/CC orders. Patients presenting with headache (33.5% of cohort) were less likely to have DNR/DNI/CC orders (RR: 0.61, 95% CI 0.41 to 0.90; p=0.008). Other symptoms had no relation with institution of DNR/DNI/CC orders. The relative risk for patients arriving comatose, to have DNR/DNI/CC orders initiated in this hospital admission (N=94) was 2.1 (p 0.0001) when compared to the non comatose. Patients with DNR/DNI/CC orders had higher hemorrhage volumes when compared to patients without these orders (median volume 73.2 cc, IQR 10.7–184.8 v/s median of 19.4 cc, IQR 5.9 – 60.1; p0.0001). Patients with intra ventricular extension (IVE) of the hemorrhage were 1.45 times more at risk to have DNR/DNI/CC orders (95% CI 1.05–2.00; p=0.022) when compared to patients without IVE. The median NIHSS score at admission for patients who had DNR/DNI/CC orders instituted (N=94) was 18, IQR 5–35; significantly higher when compared to those without these orders (median 5, IQR 1–12; p0.0001). After adjustment for sex, age, NIHSS, volume of hemorrhage and IVE, having DNR/DNI/CC orders was an independent predictor of death at 7 days (p0.0001) and at 30 days (p0.0001) in the logistic regression model. Conclusions: Patients with DNR/DNI/CC orders post ICH are more likely to be elderly, females, arrive comatose, and have higher hemorrhage volumes, intra- ventricular extension of hemorrhage, and higher NIHSS scores. In ICH, DNR orders are based predominantly on the severity of ICH and not on the basis of past medical history. DNR/DNI/CC orders themselves are independent predictors of mortality in patients of spontaneous intra-cerebral hemorrhage. 357 The Mayo Intra-Cerebral Hemorrhage Score: Evaluating Patients With Non-Traumatic Intra- Cerebral Hemorrhage Veena M, Jain A, Bellolio M, Dhillon RK, Yerragondu N, Palamari B, Gilmore RM, Decker WW, Stead LG/Mayo Clinic, Rochester, MN; University of Rochester, Rochester, NY Study Objective: To describe development of a novel outcome score (Mayo ICH score) for patients with intra-cerebral hemorrhage (ICH) and assess its associations with known indicators of ICH severity, and its co-relation with known functional outcome scores. Just like the GCS score, the Mayo ICH score was developed to give the reader a useful picture of the patient’s mental, functional and physical status. Methods: This was a cohort study of patients presenting to the emergency department (ED) in patients presenting between January 2006 and December 2008. An outcome score was developed based on medical records including physical and occupational therapy notes, The Mayo ICH score accounts for the mental, physical and functional status of patients. The score examines the mental, physical and functional status of the patient. A patient who was alert and did not have any physical or functional impairment was given a maximum score of 9.The minimum score possible was 0. Variables including age, sex, location of hemorrhage, volume of bleed and extension into the ventricular system were collected. Distributions were calculated for each of the variables. The Mayo ICH score was calculated at discharge of patients from the hospital. Results: The cohort of 245 patients had 51% females and median age 73 years (IQR 59 – 82). The median Mayo ICH score was 6 (IQR 0 – 8). Older patients (p=0.0015) had worse (lower) scores. Women had significantly lower scores (median 7; IQR 3–9) when compared to males (median 5; IQR 0 – 8; p= 0.0051). Mid-brain (p=0.027) and basal ganglia hemorrhage (p=0.004), were associated with lower scores. Patients with higher hemorrhage volumes (p0.0001) and intraventricular extension (p0.0001).of hemorrhage, which are known predictors of worse outcome also had lower scores. The median modified Rankin score, for the cohort, at discharge was 4, (IQR 1– 6). The Mayo ICH score correlated well with the modified Rankin score (Spearman’s  0.97; p0.0001). There was a linear negative correlation, higher Rankin was related to lower ICH scores (R-Square 83%). Conclusions: The user friendly outcome score was found to be significantly associated with known indicators of ICH severity. The Mayo ICH score also Research Forum Abstracts S112 Annals of Emergency Medicine Volume , .  : September 