Abstract TMP79: The Accuracy of the FUNC score to Identify Poor Prognosis in Patients with Primary Intracerebral Hemorrhage

Abstract

Background & Purpose: Recent studies suggest that intracerebral hemorrhage (ICH) clinical prediction scores (CPS) are not accurate enough to identify the cohort of patients with an extremely low chance of survival who would not benefit from further care. The early withdrawal of aggressive care, even in those with the poorest prognosis according to several CPS, has been demonstrated to be associated with worsened outcomes. Initial reports of one recently developed CPS, the FUNC score, suggest that it may more accurately identify this patient population. The aim of this study is to determine if application of do-not-resuscitate orders (DNR) within in the first 24 hours of admission impacted the prognosis of patients with predicted poor outcome. Methods: We retrospectively reviewed 501 consecutive patients with ICH who were admitted from the Emergency Department to a large healthcare system in Dallas, TX between 6/1/2009 and 6/1/2011. Patients with a predicted 100% chance of poor neurologic outcome (PNO) according to FUNC (<4) and ICH-GS(>10) scores were evaluated to determine if early DNR impacted 90 day survival or rate of survival with PNO, defined as Glasgow Outcome Score of <3. Results: Of the 501 patients with ICH, 104 were excluded due to a recognized etiology of their ICH. Data was not available in 31 patients. In the resultant 366 patients, the overall mortality at discharge was 114 (31%, 95% CI=27%-36%). Of the 68 patients who scored <4 on the FUNC, 67 (98.5%, 95% CI=92%-100%) had a PNO at discharge. Of these 68 patients, early DNR were present in 40 patients. The presence of early DNR was not associated with a significant difference in the rate of PNO at discharge (40/40=100% v. 27/28=96.4% p:0.42) or 90 day mortality (40/40=100% v. 21/28=75%, p:0.06). Of the 92 patients who scored >10 on the ICH-GS, 88 (95.6%, 95% CI=89.3-98.3) had a PNO at discharge. The presence of early DNR was associated with a significant difference in both the rate of PNO at discharge (48/48=100% v. 40/44=90.9%, p=0.048) and 90 day mortality (48/48=100% v. 34/44=77.3%, p:0.007). Conclusion: The FUNC score is able to accurately identify the subgroup of patients suffering from ICH with an extremely poor prognosis and little hope of survival to hospital discharge with good neurologic outcome.