scholarly journals Refining Prognosis for Intracerebral Hemorrhage by Early Reassessment

2017 ◽  
Vol 43 (3-4) ◽  
pp. 110-116 ◽  
Author(s):  
Matthew B. Maas ◽  
Brandon A. Francis ◽  
Rajbeer S. Sangha ◽  
Bryan D. Lizza ◽  
Eric M. Liotta ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Prognostic Score ◽  
Observational Cohort Study ◽  
Predictors Of Outcome ◽  
Neurologic Injury ◽  
Ordinal Regression Model ◽  
Observational Cohort ◽  
Ich Score ◽  
Gcs Score ◽  
Z Transformation

Background: Prognostic assessments, which are crucial for decision-making in critical illnesses, have shown unsatisfactory reliability. We compared the accuracy of a widely used prognostic score against a model derived from clinical data obtained 5 days after admission for patients with intracerebral hemorrhage (ICH), a condition for which prognostication has proven notoriously challenging and prone to bias. Methods: Patients enrolled in a prospective observational cohort study of spontaneous ICH underwent hourly Glasgow Coma Scale (GCS) assessment. Outcome was measured at 3 months using the modified Rankin Scale (mRS). We analyzed the change in correlation between GCS and 3-month mRS scores from admission through day 5, and compared the performance of a parsimonious set of day 5 clinical variables against the ICH score. Results: Data was collected on 254 subjects. The ICH score and day 5 GCS score were both correlated with 3-month mRS score (p < 0.001), but the correlation was stronger with day 5 GCS score (p < 0.05 by Fisher z-transformation). Premorbid mRS score, intraventricular hemorrhage and day 5 GCS score were independent predictors of outcome (all p < 0.05 in ordinal regression model). While ICH score correctly classified good (mRS 0-3) vs. poor (mRS 4-6) outcome in 73% of cases, the day 5 model correctly classified 83% of cases. Conclusions: A simple reassessment after 5 days of care significantly improves the accuracy of prognosticating outcome in patients with ICH. These data confirm the feasibility and potential utility of early reassessments in refining prognosis for patients who survive early stabilization of a severe neurologic injury.

A grading scale for surgically treated patients with spontaneous supratentorial intracerebral hemorrhage: the Surgical Swedish ICH Score

2020 ◽  
Vol 133 (3) ◽  
pp. 800-807 ◽  
Author(s):  
Andreas Fahlström ◽  
Henrietta Nittby Redebrandt ◽  
Hugo Zeberg ◽  
Jiri Bartek ◽  
Andreas Bartley ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Intracerebral Hemorrhage ◽  
External Validation ◽  
Grading Scale ◽  
Ich Score ◽  
Gcs Score ◽  
Strength Of Association ◽  
Point Type ◽  
Clinical Grading

OBJECTIVEThe authors aimed to develop the first clinical grading scale for patients with surgically treated spontaneous supratentorial intracerebral hemorrhage (ICH).METHODSA nationwide multicenter study including 401 ICH patients surgically treated by craniotomy and evacuation of a spontaneous supratentorial ICH was conducted between January 1, 2011, and December 31, 2015. All neurosurgical centers in Sweden were included. All medical records and neuroimaging studies were retrospectively reviewed. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the Surgical Swedish ICH [SwICH] Score) was developed using weighting of independent predictors based on strength of association.RESULTSFactors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score (p = 0.00015), ICH volume ≥ 50 mL (p = 0.031), patient age ≥ 75 years (p = 0.0056), prior myocardial infarction (MI) (p = 0.00081), and type 2 diabetes (p = 0.0093). The Surgical SwICH Score was the sum of individual points assigned as follows: GCS score 15–13 (0 points), 12–5 (1 point), 4–3 (2 points); age ≥ 75 years (1 point); ICH volume ≥ 50 mL (1 point); type 2 diabetes (1 point); prior MI (1 point). Each increase in the Surgical SwICH Score was associated with a progressively increased 30-day mortality (p = 0.0002). No patient with a Surgical SwICH Score of 0 died, whereas the 30-day mortality rates for patients with Surgical SwICH Scores of 1, 2, 3, and 4 were 5%, 12%, 31%, and 58%, respectively.CONCLUSIONSThe Surgical SwICH Score is a predictor of 30-day mortality in patients treated surgically for spontaneous supratentorial ICH. External validation is needed to assess the predictive value as well as the generalizability of the Surgical SwICH Score.

scholarly journals Anemia is an independent prognostic factor in intracerebral hemorrhage: an observational cohort study

Critical Care ◽  
2013 ◽  
Vol 17 (4) ◽  
pp. R148 ◽  
Author(s):  
Joji B Kuramatsu ◽  
Stefan T Gerner ◽  
Hannes Lücking ◽  
Stephan P Kloska ◽  
Peter D Schellinger ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prognostic Factor ◽  
Intracerebral Hemorrhage ◽  
Observational Cohort Study ◽  
Independent Prognostic Factor ◽  
Observational Cohort

Abstract P436: Outcomes in Intracerebral Hemorrhage Patients Presenting With Impaired Level of Consciousness

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ayham Alkhachroum ◽  
Antonio Bustillo ◽  
Negar Asdaghi ◽  
Erika T Marulanda-londono ◽  
Carolina M Gutierrez ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Early Recovery ◽  
Hospital Size ◽  
Stroke Registry ◽  
Level Of Consciousness ◽  
Chi Squared ◽  
Ich Score ◽  
Gcs Score

Background: Impaired level of consciousness (LOC) on presentation after intracerebral hemorrhage (ICH) may affect outcomes and the decision to withdraw life-sustaining treatment (WLST). We aim to investigate the outcomes and trends after ICH by the LOC status on presentation. Methods: We studied 37,613 cases with ICH in the Florida Stroke Registry from 2010-2019. Pearson chi-squared and Kruskall-Wallis tests were used to compare descriptive statistics. A multivariable-logistic regression with GEE accounted for basic demographics, comorbidities, ICH severity, hospital size and teaching status. Results: At stroke presentation, 12,272 (33%) cases had impaired LOC (mean age 72, 49% women, 61 white%, 20% Black, 14% Hispanic). Compared to cases with preserved LOC, LOC case were older (72 vs. 70 years old), more women (49% vs. 45%), more likely to have aphasia (38% vs. 16%), had lower GCS score (9 vs. 15), had greater ICH score (3 vs. 1), greater WLST rates (41% vs. 18%), and had greater in-hospital mortality rates (32% vs. 12%). In our adjusted model, no association was found between impaired LOC and in-hospital mortality, or length of stay. Those with preserved LOC were more likely discharged home/rehab (OR 0.4, 95%CI 0.2-0.9, p=0.03) and more likely to ambulate independently (OR 1.6, 95%CI 1.1-2.4, p=0.02). Trend analysis (2010-2019) showed decreased mortality, increased length of stay, and increased rates of discharge to home/rehab in all, regardless of the LOC status. Conclusion: In this large multi-center registry, a third of ICH cases presents with impaired LOC. Although LOC was not associated with significantly more in-hospital morality, LOC was associated with had higher rates of WLST and more disability at discharge. Future efforts should focus on biomarkers of LOC that detect early recovery and reduced disability in ICH patients with impaired LOC.

Abstract TP349: Improving Utilization of ICU Care: Change in Intracerebral Hemorrhage Admission Protocol at a Comprehensive Stroke Center

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Parneet Grewal ◽  
Deborah M Lynch ◽  
Anjali Asthana ◽  
Rhea Shrivastava ◽  
James J Conners
Keyword(s):  
Intracerebral Hemorrhage ◽  
External Ventricular Drain ◽  
Admission Rate ◽  
Retrospective Chart Review ◽  
Hematoma Expansion ◽  
Neurosurgical Procedures ◽  
Icu Admission ◽  
Coagulation Abnormalities ◽  
Ich Score ◽  
Gcs Score

Objectives: Non traumatic intracerebral hemorrhage (ICH) is responsible for 10-20% of acute stroke events and carries significant mortality concern. The protocol at our comprehensive stroke centers (CSC) is to admit all ICH patients to Neurosciences Intensive Care Unit (NSICU). We also have a stroke Intermediate Care Unit (IMCU) at our hospital which is a dedicated stroke unit where patients can be closely monitored and maintained on IV nicardipine. Optimal bed utilization is essential at our busy referral center. We aimed to develop criteria to identify ICH patients at low risk for clinical deterioration who could be admitted directly to our IMCU rather than the NSICU thereby improving overall utilization of monitored beds. Methods: Retrospective chart review for patients admitted between July 2018-Dec 2018 was performed. Age, sex, race, presenting Glasgow coma scale (GCS), ICH score, ICH volume, presence of IVH and location of the hemorrhage was documented. Patients who did not need any neurosurgical procedures (external ventricular drain, craniectomy or hematoma evacuation) and were not documented to have acute respiratory failure during their admission were considered appropriate for IMCU admission and were further assessed for hematoma expansion to determine stability throughout their hospital course. Results: 118 patients with ICH were included in the analysis, out of which 61 patients were suitable for IMCU admission. On univariable analysis, patients that had lower ICH scores (0.6±0.7 vs 2.5±0.9) and higher GCS score (14.1±1.4 vs 7.8±3.7) did not need any acute intervention. In this group of patients, only 9 (14.7%) patients had hematoma expansion documented out of which 6 (67%) patients had coagulation abnormalities on admission either due to medications or low platelet count. Conclusions: We conclude that the patients who had admission ICH score < 2, GCS ≥ 12 and no coagulation abnormalities on admission could have safely been admitted to our IMCU instead of the NSICU for further care and management. This would have led to a decrease in ICU admission rate. Application of such separate protocols for stroke IMCU admission vs ICU admission would lead to better utilization of resources at comprehensive stroke centers throughout the country.

Abstract TP310: Subarachnoid Extension of Intracerebral Hemorrhage and Perihematomal Ischemic Compression Are Related, Harmful Processes

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Matthew B Maas ◽  
Alexander J Nemeth ◽  
Neil F Rosenberg ◽  
Adam R Kosteva ◽  
James C Guth ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Binary Logistic Regression ◽  
Brain Parenchyma ◽  
Hematoma Volume ◽  
Logistic Regression Models ◽  
Ordinal Regression Model ◽  
Hemorrhage Volume ◽  
Poor Outcomes ◽  
Unique Markers ◽  
Ich Score

Background: Decreased diffusion is associated with poor outcomes in primary intracerebral hemorrhage (ICH), although the mechanism of that phenomenon is uncertain. Two distinct types of decreased diffusion have been observed, perihematomal ischemia (PHI) and distant areas of ischemia. Extension of hemorrhage into the subarachnoid (SAH) and intraventricular (IVH) compartments may be indicators of high perihematomal pressures and diminished brain parenchyma compliance. The objective of this study is to evaluate for an association between PHI and poor outcomes, and to evaluate whether PHI is associated with SAH and IVH as markers of injurious perihematomal pressure. Methods: Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed, and serial neuroimaging obtained, per a structured protocol. MRI was performed on all salvageable patients when possible. SAH, IVH and PHI were identified on imaging, along with ICH volumes, by expert reviewers blinded to outcomes. An ordinal regression model was used to evaluate for an association between PHI and modified Rankin Scale (mRS) at 28 days, adjusted for ICH Score. A binary logistic regression models was developed to identify an association between PHI and other potential predictors of malignant peri-hematomal pressures: SAH, IVH, initial hematoma volume, and supra- versus infratentorial location. Results: 94 patients were studied. 27 (28.7%) had SAH and 44 (46.8%) had IVH. PHI was associated with mRS at 28 days (odds ratio 2.88 [95% CI 1.23-6.75]), independent of ICH Score. PHI was associated with SAH (3.74 [1.25-11.21]), whereas no significant association was found with IVH, hematoma volume or location. Conclusions: PHI is independently associated with poor outcomes in primary ICH. PHI is associated with SAH, but not hemorrhage volume, location or decompression into the ventricular system. These findings suggest that PHI and subarachnoid hemorrhage extension are associated, unique markers for injurious perihematomal pressure.

scholarly journals Clinical and radiological characteristics and outcome of wake-up intracerebral hemorrhage

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Joan Martí-Fàbregas ◽  
Raquel Delgado-Mederos ◽  
Alejandro Martínez-Domeño ◽  
Pol Camps-Renom ◽  
Daniel Guisado-Alonso ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Stroke Unit ◽  
Prognostic Markers ◽  
Vascular Risk ◽  
Radiological Data ◽  
Hematoma Growth ◽  
Ich Score ◽  
Gcs Score ◽  
Prospective Database

Abstract There is little information on the characteristics of patients with wake-up intracerebral hemorrhage (WU-ICH). We aimed to evaluate frequency and relevant differences between WU-ICH and while-awake (WA) ICH patients. This is a retrospective study of a prospective database of consecutive patients with spontaneous ICH, who were classified as WU-ICH, WA-ICH or UO-ICH (unclear onset). We collected demographic, clinical and radiological data, prognostic and therapeutic variables, and outcome [(neurological deterioration, mortality, functional outcome (favorable when modified Rankin scale score 0–2)]. From a total of 466 patients, 98 (25.8%) were classified as UO-ICH according to the type of onset and therefore excluded. We studied 368 patients (mean age 73.9 ± 13.8, 51.4% men), and compared 95 (25.8%) WU-ICH with 273 (74.2%) WA-ICH. Patients from the WU-ICH group were significantly older than WA-ICH (76.9 ± 14.3 vs 72.8 ± 13.6, p = 0.01) but the vascular risk factors were similar. Compared to the WA-ICH group, patients from the WU-ICH group had a lower GCS score or a higher NIHSS score and a higher ICH score, and were less often admitted to a stroke unit or intensive care unit. There were no differences between groups in location, volume, rate of hematoma growth, frequency of intraventricular hemorrhage and outcome. One in five patients with spontaneous ICH are WU-ICH patients. Other than age, there are no relevant differences between WU and WA groups. Although WU-ICH is associated with worse prognostic markers vital and functional outcome is similar to WA-ICH patients.

scholarly journals Predictors of Outcome in Intracerebral Hemorrhage and Performance of Hemphill ICH Score and GVS Score

2021 ◽  
Vol 7 (1) ◽  
pp. 3-9
Author(s):  
Mahmudul Islam ◽  
Mashfiqul Hasan ◽  
Sudipta Kumer Mukherjee ◽  
Jobaida Naznin ◽  
Rafiqul Islam ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Intracerebral Hemorrhage ◽  
Nosocomial Pneumonia ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Rank Test ◽  
Predictors Of Outcome ◽  
Perfect Agreement ◽  
Significant Difference ◽  
Ich Score

Background: The outcome of intracerebral hemorrhage (ICH) is gloomy. There are several scoring systems for predicting its outcome. Objective: The purpose of the present study was to observe the predictors of outcome in ICH patients and to assess the performance of ‘Hemphill ICH score’ and ‘GVS score’. Methodology: This cohort study involved patients of ICH admitted within 72 hours of acute event in July to December 2017 in the Department of Neurology at National Institute of Neurosciences (NINS) & Hospital, Dhaka, Bangladesh. Clinical and radiological data at admission and in-hospital events were obtained from medical records. Patients who were discharged from the hospital were interviewed at 30th day after event by face to face interview or over telephone. Follow up data was not found for 4 patients. Results: This study involved 115 patients of ICH [median age 60 years (interquartile range, IQR 50-70); 46% (53/115) female]. In-hospital and 30-day mortality of the ICH patients was 22% (25/115: 95% CI 15-30%) and 38% (42/111; 95% CI 29–48%) respectively. There was almost perfect agreement between Hemphill ICH score and GVS score (p<0.001 and κ=0.862). Kaplan-Meier survival curves of patients with different Hemphill ICH scores revealed significant difference among them; which was also true for patients with different GVS scores (by log-rank test, p<0.001 for both). The area under the curve (AUC) for the Hemphill ICH score to predict mortality was 0.70 (95% CI, 0.60–0.80) and for the GVS score 0.74 (95% CI, 0.64–0.83). In bivariate logistic regression, NIHSS score, GCS score, blood glucose at admission, nosocomial pneumonia, ICH volume, midline shift along with both Hemphill ICH and GVS score were observed to predict mortality at 30 days (p<0.05 for all). In two separate models adjusting for blood glucose and nosocomial pneumonia, every 1-point increase in the Hemphill ICH score and GVS score increases the mortality risk by 2.35 fold (adjusted OR: 2.35; 95% CI 1.33-4.16; p=0.003) and 2.99 fold (adjusted OR: 2.99; 95% CI 1.57-5.72; p=0.001) respectively. Conclusions: Both Hemphill ICH and GVS score have comparable predicting ability of outcome in ICH. In addition to components of scoring systems, occurrence of nosocomial pneumonia and blood glucose seems important. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 3-9

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