scholarly journals Relation of Volume of Hemorrhage With Mortality Within First 48 Hours in Hemorrhagic Stroke

KYAMC Journal ◽  
2021 ◽  
Vol 12 (3) ◽  
pp. 127-132
Author(s):  
Sk Abdullah Al Mamun ◽  
Saiyeedur Rahman ◽  
Sayedur Rahman Sheikh ◽  
Abdul Wadud ◽  
Gobindo Gain
Keyword(s):  
Mortality Rate ◽  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Mortality Rates ◽  
Advanced Age ◽  
Coma Scale ◽  
Level Of Consciousness ◽  
Hemorrhage Volume ◽  
Scale 8

Background: Hemorrhagic stroke accounts for 10-15% of all strokes with higher mortality rates than cerebral infarction. Intracerebral hemorrhage has a reported 30-day mortality of 44% to 51%, with almost half of the death occurs within the first 48 hours. Advanced age, low level of consciousness, large volume of hemorrhage has been linked with poor outcome. Objectives: To predict early outcome of hemorrhagic stroke patient in relation with age, Glasgow Coma Scale, volume of hemorrhage and ventricular extension. Materials and Methods: Hospital based prospective study carried out in hundred hemorrhagic stroke patients. The formula of ABC/2 was used to calculate hemorrhage volume in bedside by using CT scan. Results: 1st month mortality rates of hemorrhagic stroke was 44% with 45.45% of patients died within the first 48 hours of onset. Mean age of patients of hemorrhagic stroke was 61.2 ± 13.88 years. Mortality rate of intracerebral hemorrhage after age of 60 was 51.06% in 1st month. Volume of intracerebral hemorrhage was the strongest predictor of both 48 hours and 30 days mortality. Using three categories of intracerebral hemorrhage (X for < 30 ml, Y for 30 - 50 ml and Z for > 50 ml group) calculated by ABC/2 formula showed 100% mortality rate in Z group, 50% in Y group and only 12% mortality rate in X group in 1st month. Among all death, 61.5% of Z group 25% of Y group and 16.67% of patients of X group died within 48 hours. Two categories of Glasgow Coma Scale (≤ 8 and ≥ 9) were used and shown death rates 80.77% in GCS ≤ 8 and 4.55% in GCS ≥ 9 in 1st month. Conclusion: Volume of intracerebral hemorrhage in combination with advanced age, initial Glasgow Coma Scale is a powerful and easy to use in both 48 hours and 1st month mortality in patients with spontaneous intracerebral hemorrhage. KYAMC Journal. 2021;12(3): 127-132

scholarly journals Correlation of Glasgow Coma Scale Score at Hospital Admission with Stroke Hemorrhagic Patient Mortality at Hasan Sadikin Hospital

2019 ◽  
Vol 2 (4) ◽  
Author(s):  
Ary Setio Hartanto ◽  
Andi Basuki ◽  
Cep Juli
Keyword(s):  
Glasgow Coma Scale ◽  
Hospital Admission ◽  
Hemorrhagic Stroke ◽  
P Value ◽  
Stroke Patients ◽  
Coma Scale ◽  
Risk Of Death ◽  
Increased Risk ◽  
Level Of Consciousness ◽  
Gcs Score

Stroke is the most common cause of death in Indonesia. Stroke is divided into ischemic and hemorrhagic stroke. Hemorrhagic stroke has a higher risk of death than ischemic stroke. Hemorrhagic stroke can disrupt patient’s consciousness. The Glasgow Coma Scale (GCS) is a scale that is widely used to assess level of consciousness. Accurate predictors can help doctors determine prognosis and treatment for stroke patient. This study was conducted to determine the correlation of GCS scores at the time of hospital admission and mortality of hemorrhagic stroke patients at Hasan Sadikin Hospital. This study is a retrospective cohort analytic study involving 134 subjects. Data were analyzed using Kolmogorov-Smirnov’s and Fisher's analysis test with significance of p <0.05. From the results of the study, the p value was 0.00, subjects with GCS score somnolence (12-14) had six times higher risk in mortality (P = 0.02, RR = 6.38) and subjects with GCS score sopor and coma (3 - 11) had twenty four times higher risk in mortality (P = 0.00, RR = 23.85). We concluded that decreased score of SKG at the time of hospital admission was associated with increased risk of death in hemorrhagic stroke patients at Hasan Sadikin Hospital.   Keywords: Glasgow Coma Scale, hemorrhagic stroke, mortality

Endovascular Aortic Repair in Patients of Advanced Age

2021 ◽  
pp. 152660282110493
Author(s):  
Mitri K. Khoury ◽  
Micah A. Thornton ◽  
Christopher A. Heid ◽  
Jacqueline Babb ◽  
Bala Ramanan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Survival Benefit ◽  
Elective Surgery ◽  
Endovascular Aneurysm Repair ◽  
The Elderly ◽  
Mortality Rates ◽  
Current Data ◽  
Aortic Aneurysms ◽  
Advanced Age ◽  
The Impact

Purpose: Treatment decisions for the elderly with abdominal aortic aneurysms (AAAs) are challenging. With advancing age, the risk of endovascular aneurysm repair (EVAR) increases while life expectancy decreases, which may nullify the benefit of EVAR. The purpose of this study was to quantify the impact of EVAR on 1-year mortality in patients of advanced age. Materials and Methods: The 2003–2020 Vascular Quality Initiative Database was utilized to identify patients who underwent EVAR for AAAs. Patients were included if they were 80 years of age or older. Exclusions included non-elective surgery or missing aortic diameter data. Predicted 1-year mortality of untreated AAAs was calculated based on a validated comorbidity score that predicts 1-year mortality (Gagne Index, excluding the component associated with AAAs) plus the 1-year aneurysm-related mortality without repair. The primary outcome for the study was 1-year mortality. Results: A total of 11 829 patients met study criteria. The median age was 84 years [81, 86] with 9014 (76.2%) being male. Maximal AAA diameters were apportioned as follows: 39.6% were <5.5 cm, 28.6% were 5.5–5.9 cm, 21.3% were 6.0–6.9 cm, and 10.6% were ≥7.0 cm. The predicted 1-year mortality rate without EVAR was 11.9%, which was significantly higher than the actual 1-year mortality rate with EVAR (8.2%; p<0.001). The overall rate of perioperative MACE was 4.4% (n = 516). Patients with an aneurysm diameter <5.5cm had worse actual 1-year mortality rates with EVAR compared to predicted 1-year mortality rates without EVAR. In contrast, those with larger aneurysms (≥5.5cm) had better actual 1-year mortality rates with EVAR. The benefit from EVAR for those with Gagne Indices 2–5 was largely restricted to those with AAAs ≥ 7.0cm; whereas those with Gagne Indices 0–1 experience a survival benefit for AAAs larger than 5.5 cm. Conclusion: The current data suggest that EVAR decreases 1-year mortality rates for patients of advanced age compared to non-operative management in the elderly. However, the survival benefit is largely limited to those with Gagne Indices 0–1 with AAAs ≥ 5.5 cm and Gagne Indices 2–5 with AAAs ≥ 7.0 cm. Those of advanced age may benefit from EVAR, but realizing this benefit requires careful patient selection.

scholarly journals Spontaneous Intracerebral Haemorrhage: An Analysis of Factors Affecting Prognosis

1985 ◽  
Vol 12 (3) ◽  
pp. 267-271 ◽  
Author(s):  
A.A. Dixon ◽  
R.O. Holness ◽  
W.J. Howes ◽  
J.B. Garner
Keyword(s):  
Glasgow Coma Scale ◽  
Intracerebral Haemorrhage ◽  
Clinical Factors ◽  
Partial Pressure Of Oxygen ◽  
Factors Affecting ◽  
Coma Scale ◽  
Level Of Consciousness ◽  
Ventricular Rupture ◽  
Predicting Outcome ◽  
Spontaneous Intracerebral Haemorrhage

ABSTRACT:A retrospective study of 100 patients with spontaneous intracerebral haemorrhage was carried out, to identify clinical factors which have a predictive value for outcome. Numerical equivalents for the admission level of consciousness (the Glasgow Coma Scale), ventricular rupture, partial pressure of oxygen in the blood, the electrocardiogram, clot location, and clot size were combined into equations predicting outcome. The best single parameter for prediction was the Glasgow Coma Scale.

Mortality by Decade in Trauma Patients with Glasgow Coma Scale 3

2011 ◽  
Vol 77 (10) ◽  
pp. 1342-1345 ◽  
Author(s):  
Eric J. Ley ◽  
Morgan A. Clond ◽  
Omar N. Hussain ◽  
Marissa Srour ◽  
James Mirocha ◽  
...  
Keyword(s):  
Los Angeles ◽  
Glasgow Coma Scale ◽  
Trauma System ◽  
Mortality Rates ◽  
High Survival ◽  
Trauma Patients ◽  
Coma Scale ◽  
The Third ◽  
Aggressive Care ◽  
Improvement In Survival

The aim of this study was to assess how increasing age affects mortality in trauma patients with Glasgow Coma Scale (GCS) 3. The Los Angeles County Trauma System Database was queried for all patients aged 20 to 99 years admitted with GCS 3. Mortality was 41.8 per cent for the 3306 GCS 3 patients. Mortality in the youngest patients reviewed, those in the third decade, was 43.5 per cent. After logistic regression analysis, patients in the third decade had similar mortality rates to patients in the sixth (adjusted OR, 0.88; CI, 0.68 to 1.14; P = 0.33) and seventh decades (adjusted OR, 0.96; CI, 0.70 to 1.31; P = 0.79). A significantly lower mortality rate, however, was noted in the fifth decade (adjusted OR, 0.76; CI, 0.61 to 0.95; P = 0.02). Conversely, significantly higher mortality rates were noted in the eighth (adjusted OR, 1.93; CI, 1.38 to 2.71; P = 0.0001) and combined ninth/tenth decades (adjusted OR, 2.47; CI, 1.71 to 3.57; P < 0.0001). Given the high survival in trauma patients with GCS 3 as well as continued improvement in survival compared with historical controls, aggressive care is indicated for patients who present to the emergency department with GCS 3.

scholarly journals Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severity

2018 ◽  
Vol 128 (6) ◽  
pp. 1612-1620 ◽  
Author(s):  
Paul M. Brennan ◽  
Gordon D. Murray ◽  
Graham M. Teasdale
Keyword(s):  
Patient Outcome ◽  
Mortality Rate ◽  
Glasgow Coma Scale ◽  
Brain Damage ◽  
Unfavorable Outcome ◽  
Simple Arithmetic ◽  
Coma Scale ◽  
Pupil Response ◽  
Gcs Score ◽  
Complex Methods

OBJECTIVEGlasgow Coma Scale (GCS) scores and pupil responses are key indicators of the severity of traumatic brain damage. The aim of this study was to determine what information would be gained by combining these indicators into a single index and to explore the merits of different ways of achieving this.METHODSInformation about early GCS scores, pupil responses, late outcomes on the Glasgow Outcome Scale, and mortality were obtained at the individual patient level by reviewing data from the CRASH (Corticosteroid Randomisation After Significant Head Injury; n = 9,045) study and the IMPACT (International Mission for Prognosis and Clinical Trials in TBI; n = 6855) database. These data were combined into a pooled data set for the main analysis.Methods of combining the Glasgow Coma Scale and pupil response data varied in complexity from using a simple arithmetic score (GCS score [range 3–15] minus the number of nonreacting pupils [0, 1, or 2]), which we call the GCS-Pupils score (GCS-P; range 1–15), to treating each factor as a separate categorical variable. The content of information about patient outcome in each of these models was evaluated using Nagelkerke’s R2.RESULTSSeparately, the GCS score and pupil response were each related to outcome. Adding information about the pupil response to the GCS score increased the information yield. The performance of the simple GCS-P was similar to the performance of more complex methods of evaluating traumatic brain damage. The relationship between decreases in the GCS-P and deteriorating outcome was seen across the complete range of possible scores. The additional 2 lowest points offered by the GCS-Pupils scale (GCS-P 1 and 2) extended the information about injury severity from a mortality rate of 51% and an unfavorable outcome rate of 70% at GCS score 3 to a mortality rate of 74% and an unfavorable outcome rate of 90% at GCS-P 1. The paradoxical finding that GCS score 4 was associated with a worse outcome than GCS score 3 was not seen when using the GCS-P.CONCLUSIONSA simple arithmetic combination of the GCS score and pupillary response, the GCS-P, extends the information provided about patient outcome to an extent comparable to that obtained using more complex methods. The greater range of injury severities that are identified and the smoothness of the stepwise pattern of outcomes across the range of scores may be useful in evaluating individual patients and identifying patient subgroups. The GCS-P may be a useful platform onto which information about other key prognostic features can be added in a simple format likely to be useful in clinical practice.

Association of Glasgow Coma Scale with Total Homocysteine Levels in Patients with Hemorrhagic Stroke

2019 ◽  
Vol 75 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Dapeng Dai ◽  
Yong Sun ◽  
Chengzhang Liu ◽  
Houxun Xing ◽  
Binyan Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glasgow Coma Scale ◽  
Hemorrhagic Stroke ◽  
Final Analysis ◽  
Inverse Association ◽  
Severe Damage ◽  
Coma Scale ◽  
Total Homocysteine ◽  
The Mean ◽  
Stratified Analysis

Objectives: We aimed to evaluate the association between Glasgow Coma Scale (GCS) and total homocysteine (tHcy) levels and examine the possible effect modifiers in patients with hemorrhagic stroke. Methods: A total of 1,516 participants with hemorrhagic stroke and having the complete data on baseline GCS and tHcy measurements were included in the final analysis. Results: The mean (SD) of age, tHcy, and GCS levels were 61.5 (11.3) years, 17.0 (10.3) μmol/L, and 13.9 (2.2), respectively. Compared with participants with severe damage (GCS <9), those with mild damage (GCS ≥13) had significantly lower transformed tHcy levels (β = –2.46; 95% CI –4.80 to –0.12). Consistently, a significantly lower transformed tHcy levels were found in participants with mild damage (GCS ≥13; β = –1.37; 95% CI –2.66 to –0.08) compared with those with moderate to severe damage (GCS <13). In the stratified analysis, a stronger inverse association between GCS categories (≥13 vs. <13) and tHcy concentrations was observed in ever smokers (vs. never; p for interaction = 0.045), and in participants with systolic blood pressure (SBP) ≥160 mm Hg (vs. <160 mm Hg; p for interaction = 0.031), or total cholesterol (TC) ≥5.2 mmol/L (vs. <5.2 mmol/L; p for interaction = 0.025). Conclusion: There was an inverse association between GCS level and tHcy concentration among patients with hemorrhagic stroke, especially in ever smokers or in participants with higher SBP or TC levels.

Impact of ischemic heart disease and atrial fibrillation on survival after spontaneous intracerebral hemorrhage

2008 ◽  
Vol 108 (6) ◽  
pp. 1172-1177 ◽  
Author(s):  
Sami Tetri ◽  
Liisa Mäntymäki ◽  
Seppo Juvela ◽  
Pertti Saloheimo ◽  
Juhani Pyhtinen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Mortality Rate ◽  
Intracerebral Hemorrhage ◽  
Ischemic Heart Disease ◽  
Mortality Rates ◽  
Ischemic Heart ◽  
University Hospital ◽  
Spontaneous Intracerebral Hemorrhage

Object The well-known predictors for increased early deaths after spontaneous intracerebral hemorrhage (ICH) include the clinical and radiological severity of bleeding as well as being on a warfarin regimen at the onset of stroke. Ischemic heart disease and atrial fibrillation may also increase early deaths. In the present study the authors aimed to elucidate the role of the last 2 factors. Methods The authors assessed the 3-month mortality rate in patients with spontaneous ICH (453 individuals) who were admitted to the stroke unit of Oulu University Hospital within a period of 11 years (1993–2004). Results The 3-month mortality rate for the 453 patients was 28%. The corresponding mortality rates were 42% for the patients who had ischemic heart disease and 61% for those with atrial fibrillation on admission. The following independent predictors of death emerged after adjustment for sex and the use of warfarin or aspirin at the onset of ICH: 1) ischemic heart disease (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.12–2.48, p < 0.02); 2) atrial fibrillation on admission (HR 1.79, 95% CI 1.12–2.86, p < 0.02); 3) the Glasgow Coma Scale score on admission (HR 0.82 per unit, 95% CI 0.79–0.87, p < 0.01); 4) size of hematoma (HR 1.11 per 10 ml, 95% CI 1.07–1.16, p < 0.01); 5) intraventricular hemorrhage (HR 2.62, 95% CI 1.71–4.02, p < 0.01); 6) age (HR 1.04 per year, 95% CI 1.02–1.06, p < 0.01); and 7) infratentorial location of the hematoma (HR 1.93, 95% CI 1.26–2.97, p < 0.01). Conclusions Both ischemic heart disease and atrial fibrillation independently and significantly impaired the 3-month survival of patients with ICH.

scholarly journals INTRACEREBRAL HEMORRHAGE (ICH) INCIDENCE PROFILE IN JEMURSARI ISLAMIC HOSPITAL DURING THE PERIOD 2017-2019

2022 ◽  
Vol 5 (1) ◽  
pp. 41-48
Author(s):  
Hidayatullah Hidayatullah ◽  
Shobihatus Syifak ◽  
Choirotussanijjah Choirotussanijjah
Keyword(s):  
Mortality Rate ◽  
Intracerebral Hemorrhage ◽  
Medical Records ◽  
Hemorrhagic Stroke ◽  
Epidemiological Studies ◽  
Brain Parenchyma ◽  
Type B ◽  
Medical Record Data ◽  
Record Data ◽  
Male Patients

Background: Intracerebral hemorrhage or ICH or hemorrhagic stroke is caused by bleeding within brain parenchyma. Riskesdas reported that stroke patients in Indonesia experienced an increase from 7 permil in 2013 to 10.9 permil in 2018. Mortality rate for ICH is estimated 40% in 1 month and 54% in 1 year. Rumah sakit Islam Jemursari (RSI) is the only type B hospital in Wonocolo sub-district, Surabaya city. This study aimed to analyze the pattern of incidents and variations of ICH at RSI Jemursari Surabaya.Method: This was a descriptive observational study. Medical record data is collected  from 2017-2019. The data were obtained from medical records section of total number of ICH, gender, age and outcome of patients. Furthermore, data is analyzed and illustrated through a bar chart and the frequency of mortality is calculated.Results: Total ICH patients at Jemursari Hospital were 310 with 192 male patients and 118 female patients over 3 years. Meanwhile, the most groups experienced ICH were 45-64 years, followed by +65 age group. This is consistent with several epidemiological studies related to ICH, where the incidence of ICH increases with increasing age. The mortality rate for ICH patients, in the 2017-2019 periode, was around 23-30%.Conclusion: It can be concluded that male more susceptible to ICH than female subjects. Meanwhile, the mortality rate for ICH patients ranged from 23-30% in the 2017-2019 period. It is necessary to carry out further evaluation related to other data from the patient. So it could describe incidence rate as well as an overview of the ICH profile at RSI Jemursari.

Abstract TP330: Insular Cortex Lesions are Associated With Early Mortality in Patients With Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Luis Prats-Sánchez ◽  
Fernando Fayos ◽  
Elba Pascual-Goñi ◽  
Celia Painous ◽  
Pol Camps-Renom ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Independent Predictor ◽  
Tertiary Care ◽  
Insular Cortex ◽  
Brain Atlas ◽  
Lesion Volume ◽  
Care Hospital ◽  
Cox Regression Analysis ◽  
Coma Scale

Introduction: Insular lesions have been described as an independent predictor of death in acute ischemic stroke. This study was undertaken to determine the influence of insular damage on the mortality of patients with intracerebral hemorrhage (ICH). Hypothesis: Insular cortex lesions are an independent predictor of death in acute ICH. Methods: This is an observational study of consecutive patients with spontaneous acute ICH who were admitted to a tertiary care hospital. The following data were collected prospectively: age, sex, traditional vascular risk factors, vital signs, CT findings (secondary intraventricular hemorrhage, hematoma volume), Glasgow Coma Scale score, time and cause of death within hospitalization. The insular cortex damage (right, left or any) was assessed by a blind evaluator using an interactive brain atlas. The association between insular lesions and mortality was investigated by use of logistic regression and Cox proportional hazards models. Results: We included 276 patients whose mean age was 77±14.3 years; 52.7% of them were men. During a median of 7 days (interquartile range 2-15) of hospitalization, 91 (32.9%) deaths were recorded. We observed 72 (26%) patients with insular cortex lesions (right insula=34, left insula=38). Cox regression analysis showed that age (adjusted hazard ratio [aHR] 1.02, 95% CI 1.00-1.04; p<0.001), Glasgow Coma Scale (aHR 0.84, 95% CI 0.80-0.89; p<0.001), lesion volume (aHR 1.10, 95% CI 1.06-1.15; p<0.001) and any insular damage (aHR 2.19, 95% CI 1.40-3.42, p=0.002) were significant predictors of death within hospitalization. Conclusions: In conclusion, insular cortex lesions adversely influence survival after spontaneous ICH. This finding was observed even after adjustment for other well-known predictors of ICH mortality.

Frontal bur hole through an eyebrow incision for image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

2012 ◽  
Vol 117 (4) ◽  
pp. 767-773 ◽  
Author(s):  
Justin A. Dye ◽  
Joshua R. Dusick ◽  
Darrin J. Lee ◽  
Nestor R. Gonzalez ◽  
Neil A. Martin
Keyword(s):  
Glasgow Coma Scale ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Invasive Technique ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Midline Shift ◽  
Hematoma Volume ◽  
Coma Scale ◽  
Endoscopic Evacuation ◽  
The Mean

Object Surgical evacuation of spontaneous intracerebral hemorrhage (sICH) remains a subject of controversy. Minimally invasive techniques for hematoma evacuation have shown a trend toward improved outcomes. The aim of the present study is to describe a minimally invasive alternative for the evacuation of sICH and evaluate its feasibility. Methods The authors reviewed records of all patients who underwent endoscopic evacuation of an sICH at the UCLA Medical Center between March 2002 and March 2011. All patients in whom the described technique was used for evacuation of an sICH were included in this series. In this approach an incision is made at the superior margin of the eyebrow, and a bur hole is made in the supraorbital bone lateral to the frontal sinus. Using stereotactic guidance, the surgeon advanced the endoscopic sheath along the long axis of the hematoma and fixed it in place at two specific depths where suction was then applied until 75%–85% of the preoperatively determined hematoma volume was removed. An endoscope's camera, then introduced through the sheath, was used to assist in hemostasis. Preoperative and postoperative hematoma volumes and reduction in midline shift were calculated and recorded. Admission Glasgow Coma Scale and modified Rankin Scale (mRS) scores were compared with postoperative scores. Results Six patients underwent evacuation of an sICH using the eyebrow/bur hole technique. The mean preoperative hematoma volume was 68.9 ml (range 30.2–153.9 ml), whereas the mean postoperative residual hematoma volume was 11.9 ml (range 5.1–24.1 ml) (p = 0.02). The mean percentage of hematoma evacuated was 79.2% (range 49%–92.7%). The mean reduction in midline shift was 57.8% (p < 0.01). The Glasgow Coma Scale score improved in each patient between admission and discharge examination. In 5 of the 6 patients the mRS score improved from admission exam to last follow-up. None of the patients experienced rebleeding. Conclusions This minimally invasive technique is a feasible alternative to other means of evacuating sICHs. It is intended for anterior basal ganglia hematomas, which usually have an elongated, ovoid shape. The approach allows for an optimal trajectory to the long axis of the hematoma, making it possible to evacuate the vast majority of the clot with only one pass of the endoscopic sheath, theoretically minimizing the amount of damage to normal brain.

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