Optimising the management of spontaneous intracerebral haemorrhage: the ActúA project. Expert recommendations on the management of spontaneous intracerebral haemorrhage.

INTRODUCTION: Spontaneous intracerebral haemorrhage (ICH) is a neurological emergency. While code stroke has improved the management of ischaemic stroke in Spain, ICH lacks a specific protocol, leading to significant variability in its treatment. The ActúA project aims to standardise ICH care through recommendations tailored to the Spanish healthcare system.

MATERIAL AND METHODS: The project was conducted in four phases: 1) initial recommendation proposal by a multidisciplinary scientific committee (MSC); 2) 7 regional workshops to review and assess applicability; 3) final version prepared by the MSC; and 4) final validation using the Delphi methodology. Indicators were defined to evaluate the implementation and impact of the recommendations.

RESULTS: The MSC identified key areas and proposed a total of 42 recommendations (17 pre-hospital, 12 in-hospital, and 13 post-discharge). These address, among other aspects, code stroke activation, the use of validated neurological scales, the implementation of essential care bundles, and early rehabilitation. Simultaneously, 27 clinical performance indicators were established. Subsequently, 217 healthcare professionals participated in the regional workshops. Finally, 43 experts took part in the validation phase, achieving consensus on all recommendations in a single round.

CONCLUSIONS: The ActúA project provides a comprehensive framework for standardising ICH management in Spain, based on the available evidence and the consensus of a multidisciplinary panel. The coordinated implementation of these recommendations has the potential to contribute to more consistent and structured care, laying the groundwork for the development of a future national "code ICH."