Abstract
(1) Background: The goal of this study was to determine the incidence of in-hospital mortality and to investigate its predictors in patients with a primary intracranial hemorrhage (ICH) undergoing endotracheal intubation. (2) Methods: This retrospective study, between July 2018 to July 2019, recruited patients who were diagnosed with a primary ICH and who were intubated during treatment in our institution. The outcome variable was in-hospital mortality, known as 30-day mortality, in patients with ICH undergoing endotracheal intubation. Multivariable analyses were performed to identify the prediction of in-hospital mortality. (3) Results: A total of 180 patients with ICH undergoing endotracheal intubation were included, with a mean (SD) age of 62.64 (13.82) years. A total of 73.33% were female, and 71.11% of the patients were indicated for intubation due to neurological reasons. The in-hospital mortality rate, following endotracheal intubation, was 58.33%. In a reduced model using a stepwise backward selection strategy with p values < 0.2, independent predictors of in-hospital mortality were brain herniations on cranial CT scans (OR: 10.268, 95% CI: 2.749–38.344), lower Glasgow coma scale (CGS) scores before intubation (OR: 0.614, 95% CI: 0.482–0.782), and the loss of the vertical oculocephalic reflex before intubation (OR: 6.288, 95% CI: 2.473–15.985). Conclusions: The in-hospital mortality rate was comparable to that in the early evidence, but was significantly higher compared to recent reports. We infer that brain herniations on cranial CT imaging, lower CGS scores before intubation, and the loss of the vertical oculocephalic reflex before intubation could be used to approximately predict in-hospital mortality in patients with primary ICH undergoing endotracheal intubation. These considerations can help guide clinical decisions and community stroke discussions.
Highlights
Intracranial hemorrhage (ICH) is a significant medical event that accounts for up to 15% of strokes [1]
The in-hospital mortality rate was comparable to that in the early evidence, but was significantly higher compared to recent reports
We infer that brain herniations on cranial computed tomography (CT) imaging, lower CGS scores before intubation, and the loss of the vertical oculocephalic reflex before intubation could be used to approximately predict in-hospital mortality in patients with primary ICH undergoing endotracheal intubation
Summary
Intracranial hemorrhage (ICH) is a significant medical event that accounts for up to 15% of strokes [1]. The incidence of ICH is approximately 25 per 100,000 person-years, and it has a mortality of 40% within one month of presentation [1]. A systematic review from 56 population-based studies suggested that, compared to high-income countries, lowand middle-income countries had a twice-higher incidence of primary ICH (22 vs 10 per 100,000 person-years) from 2000–2008 [5]. According to the most recent data in Vietnam—a lower- and middle-income country in Southeast Asia—the overall prevalence of strokes between 2013 and 2014 was 1.62%, with the highest incidence in Can Tho (4.81%) and the lowest in Gia Lai (0.36%). A study across Vietnam by Le Van Thinh (2008) in 78 provincial, city, and central hospitals suggested that the mortality rates from strokes in health facilities were 4.4% in the north, 4.1% in the central, and 5% in the south regions of Vietnam [6]. National data on ICH has been not available in this country, which still requires up-to-date evidence from different major health centers
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