Utility of Intracerebral Hemorrhage Score for Predicting Prognostic Value in Hypertensive Bleed

Khambu B*, Paudel P**, Bista P*****, Sharma RK*, Deo K**, Jha Rajiv****, Shrestha R**, Dhungana S***, Khadka N****, Sharma GR*****,

Abstract


Introduction: Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes and there is no treatment of proven benefit. Despite several existing outcome prediction models for ICH, there is no standard clinical grading scale for ICH analogous to those for traumatic brain injury, subarachnoid hemorrhage, or ischemic stroke.

Method: Records of all patients with acute ICH presenting to Bir Hospital (NAMS), Mahaboudha, Kathmandu during March 1st to June 29th 2017 were prospectively collected. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the age modified ICH Score) was developed with weighting of independent predictors based on strength of association.

Result: Factors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score (P=0.028), age ≥65 years (P=0.001), ICH volume (P =0.02), and presence of Intraventricular hemorrhage (IVH) (P 0.30). The ICH Score was the sum of individual points assigned as follows: GCS score 3 to 4 (=2 points), 5 to 12 (=1), 13 to 15 (=0); age ≥65years yes (=1), no (=0); infratentorial origin yes (=1), no (=0); ICH volume ≥30 cm3 (=1), ,<30 cm3 (=0); and IVH yes (=1), no (=0). No patient of Age modified ICH score was alive and 83% of the Age modified ICH score of 3 or 4 were dead. Other with the score of 0, 1, 2 were all alive.Thirty -day mortality increased with Age modified ICH Score (P-value< 0.001).

Conclusion: The Age modified ICH Score is a simple clinical grading scale that allows risk stratification on presentation with ICH. The use of a scale such as the ICH Score could improve standardization of clinical treatment protocols and clinical research studies in ICH.30

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