Correlation between Intracerebral Hemorrhage Score and surgical outcome of spontaneous intracerebral hemorrhage

Mr Islam,Kk Barua,M Hossain,R Amin,Ma Hossain,Hu Rashid,A Rahman

doi:10.3329/bmrcb.v39i1.15789

Abstract

Spontaneous intracerebral hemorrhage (ICH) comprises 10-15% of all strokes and has a higher risk of morbidity and mortality (40-45%). A simple and widely valid clinical grading scale, the Intracerebral Hemorrhage Score (ICH score) was developed to predict to outcome of spontaneous ICH. The aim of the present study was to assess the relation between the ICH score and the surgical outcome of ICH by Glasgow Outcome Scale (GOS) at the 30th post ictus day in our perspective. This prospective study was done during the period of April 2009 to October 2010 in Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Forty three cases were enrolled by set inclusion and exclusion criteria. Intracerebral Hemorrhage Score was calculated during admission and the surgical outcome of ICH was determined by GOS by face to face or telephone interview using structured questionnaire on their 30th post ictus day. Correlation between the ICH score and the surgical outcome of ICH was done by Pearson's correlation coefficient test. Value of r was found to be -0.635 which was statistically highly significant (p = .001) and the relation was found to be negative. Higher ICH score had unfavorable outcome As correlation between the ICH score and the surgical outcome of ICH was found statistically highly significant, it can be used widely as a grading scale in preoperative counseling. The use of ICH score could improve standardization of clinical treatment protocols and clinical research studies in ICH.

Highlights

Spontaneous intracerebral hemorrhage (ICH) is defined as bleeding into brain parenchyma without accompanying trauma
Previous studies have shown the ability of the ICH score to predict functional outcome as measured by mRS at 12 months[10] and disability as measured by Glasgow Outcome Scale (GOS) at six months.[11]
We found co-morbidities like hypertension a very important predisposing factor (58.14%) for spontaneous intracerebral hemorrhage

Summary

Introduction

Spontaneous intracerebral hemorrhage (ICH) is defined as bleeding into brain parenchyma without accompanying trauma. Despite improvements in neurological intensive care, less than one-third of patients with ICH make a good functional recovery. Within 30 days of the ICH ictus, 35–52% of patients are likely to die, and only 20% are expected to be functionally independent at 6 months. There is no proven effective treatment and tools for predicting the outcome of this fatal disease[2]. Clinical grading scales play an important role in the evaluation and management of patients with acute neurological disorders. Despite the common occurrence and high morbidity of ICH, there remains no widely used clinical grading scale for ICH. The ICH score, which is simple and effective, seems to be a standard neurological assessment tool that is reproducible and reliable for predicting outcome of ICH5

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