Prognostic factors in a series of 185 consecutive spontaneous supratentorial intracerebral haematomas

Abstract

We report a retrospective observational study of 185 cases with spontaneous supratentorial intracerebral haemorrhage, in which, by univariate and multivariate analysis, the main clinical and CT findings influencing patient outcome were studied. Forty (22%) patients died and 77 (41%) remained in a very disabled state. Using logistic regression analysis we found that the volume of the haematoma, its deep location, surgical treatment and the preictal status in relation to activities of daily living (ADL) were independent factors for patient outcome measured with the Modified Rankin Scale. Similarly, GCS at presentation, preictal status in relation to ADL and age were directly correlated with mortality at 6 months follow-up. We also observed that age, GCS at admission and the volume of the haematoma, were the main factors influencing the neurosurgeon's decision regarding surgical treatment.

Predicting Mortality in Spontaneous Intracerebral Hemorrhage

“…8,29 The GCS score is a standard neurological assessment tool that is reproducible and reliable, and it has been associated with SICH outcome in other prediction models. 7,11,14,26,30,31 To grade GCS contribution, we categorized the division of the scale into 4 instead of 3 items assuming that the influence of level of consciousness on outcome is prominent regardless of other factors, and patients with GCS scores of 13 tend toward much worse outcome. [32][33][34] To grade SICH volume contribution, we categorized the division of the scale into 3 instead of 2 items assuming that SICH is not a single-phase event, the mechanisms of growth are not the same for the small, medium, and large hematomas, 26 and rebleeding occurs in Ϸ20% to 38% of cases 35,36 with a neurological deterioration.…”

“…The oICH score was applied to our prospective cohort using identical cutoff values and points for age, GCS, ICH volume, IVH, and infratentorial origin as by Hemphill et al 7 Two modified ICH (mICH) scores were created (mICH-A score and mICH-B score) after a revision of the literature 28 using the same ICH variables with the exception of the infratentorial origin item because it has not a sure prognostic value. 11,12,18,25,26 Four variables were categorized and recoded to permit calculation of the mICH scores. These calculations are summarized in Table 1.…”

“…8 Several prognostic models for mortality and functional outcome after SICH have been proposed. They vary in complexity, including terms for degree of hydrocephalus, 9 intraventricular hemorrhage (IVH), 10 neurological condition, 11,12 clinical and laboratory parameters, 1,13,14 neuroimaging findings, 1,10,11,14,15 and in feasibility by personnel not specifically trained in neuroimaging and statistical analysis. 16 Although several clinical and radiological profiles have consistently been predictive of mortality or dependency, 17 in many instances, the studies that validate these prognostic factors represent class III or class IV evidence.…”

Intra-cerebral haemorrhages: are there any differences in baseline characteristics and intra-hospital mortality between hospitaland population-based registries?

“…Most of our knowledge on the epidemiology of nontraumatic intra-cerebral haemorrhages (ICH) comes from (i) population-based registries [1,7,21] in which selection bias are minimised, but where information regarding causes, treatments, modalities of management, and outcomes are limited; (ii) hospital-based cohorts, biased by the selected recruitment of each speciality involved, i. e. neurology [16], neurosurgery [5], or intensive care [20]; (iii) cohorts included in therapeutic trials, which usually have a poor external validity [17][18][19].…”

Influence of Intracerebral Hemorrhage Location on Incidence, Characteristics, and Outcome

“…8,9 However, most ICHs are supratentorial and the influence of supratentorial ICH location on outcome remains unclear. Lobar ICH may have a better prognosis in comparison with ICH in other locations, [10][11][12][13] or it may not, [14][15][16][17][18][19][20] and the risk of recurrence may be higher after lobar ICH. 21 Determining whether risk factors and outcome differ according to ICH location has been further complicated by studies' varied definitions of ICH location.…”