Utility of Intracranial Haemorrhage Score in Non Traumatic Intracranial HaemorrhageA Longitudinal Study

Abstract

Introduction: Intracranial Haemorrhage (ICH) is any bleeding that occurs inside the intracranial vault, which includes the brain parenchyma and the surrounding meningeal spaces. It is a devastating illness associated with significant morbidity and mortality. The ICH score was developed in 2001 as a predictive tool for mortality. It is a six point score based on five components i.e, age, ICH volume, Intraventricular Haemorrhage (IVH), site of bleed and Glasgow Coma Scale (GCS). Aim: To study the utility of ICH score for predicting 30 day mortality and morbidity and also to determine if ICH calculated 24 hours after admission is a better indicator of mortality. Materials and Methods: This was a longitudinal observational study conducted among 235 patients, with spontaneous ICH, who were admitted in the Department of General Medicine, Government Medical College, Kozhikode, Kerala, India, from January 2019 to December 2019. Data collected included risk factors, clinical features and Glasgow Coma Scale (GCS), and Computed Tomography (CT) findings. The ICH score was calculated at the time of presentation and after 24 hours. Functional status of the patients were assessed using modified Rankin Scale (mRS) on day 30 of the illness. Chi-square test was used to analyse categorical variables. Odds ratio was calculated. Relation between ICH score and mRS on day 30 was analysed using logistic regression. A p-value <0.05 was taken as statistically significant. Results: The mean age of the study population was 61.52±12.67 years. Overall, 136 patients were males (57.9%). Prevalence of hypertension, diabetes mellitus, dyslipidemia, and alcohol abuse were 85.5%, 34%, 31.9% and 17%, respectively. There were 60 deaths (25.5%). All components of ICH score i.e, age (OR=5.39), GCS (OR=488.65), ICH volume (OR=5.519), IVH (OR=29.08), and site of ICH (OR=18.32) as well as newer parameters, like, the presence of hydrocephalus (OR=18.32), midline shift (OR=7.49) and anisocoria (OR=12.25) were significant predictors of mortality (p-value <0.05). Hemiplegia (177, 75.3%) was the most common, and seizure (24, 10.2%) was the least common presentation. Mortality rate was higher in those with higher ICH scores (100% for scores 4 and 5, and 79.3% for score 3). Receiver Operating Characteristic (ROC) curve with ICH score of 3 as cut-off predicted outcome with an accuracy of 94.9% (90% sensitivity and 96.6% specificity). Conclusion: Intracranial haemorrhage score is a practical tool in predicting patient outcome in patients with ICH. The ICH score calculated after 24 hours was observed not to be superior to that calculated at the time of admission.