In a Canadian study of 49 hospitals that included ICH patients, a higher proportion of registered nurses at the hos- pital and better nurse-physician communication were inde- pendently associated with lower 30-day mortality even after adjustment for disease severity, comorbidities, and hospital Hemphill et al Management of Spontaneous ICH 2041 In a Swedish study of 86 hospitals, stroke unit care was associated with a lower risk of death or institu- tional living after 3 months in patients with ICH (OR, 0.60; General Monitoring and Nursing Care: Recommendation Initial monitoring and management of ICH patients should take place in an intensive care unit or dedi- cated stroke unit with physician and nursing neu- roscience acute care expertise (Class I; Level of Evidence B). (Revised from the previous guideline) Glucose Management High blood glucose on admission predicts an increased risk of mortality and poor outcome in patients with ICH, indepen- dent of the presence of diabetes mellitus.140 144 A randomized trial showing improved outcomes with tight glucose control (range, 80 110 mg/dL) using insulin infusions in mainly surgical critical care patients141 has increased the use of this therapy. However, more recent studies have demonstrated an increased incidence of systemic and cerebral hypoglycemic events and possibly even an increased risk of mortality in patients treated with this regimen.145 148 A cluster randomized trial of a set of interventions (managing glucose, fever, and swallowing dysfunction in stroke units) found improved out- comes in a mixed cohort of ischemic and hemorrhagic stroke At present, the optimal management of hypergly- cemia in ICH and the target glucose level remains to be clari- fied. Hypoglycemia should be avoided. Glucose Management: Recommendation Glucose should be monitored. Both hyperglyce- mia and hypoglycemia should be avoided (Class I; Level of Evidence C). 