Recurrent brain hemorrhage and mortality in two university medical centers

Abstract

Background: The temporal course of rebleed after intracerebral hemorrhage (ICH) is unknown. To test the hypothesis that mortality may be predicted by rebleed in 24 hours, we surveyed ICH admissions to the University of Michigan (UM) and University of Kentucky (UK) Medical Centers over 2 years. Methods: All cases of ICH (ICD-9 431) admitted to UM or UK between July 2000 and June 2002 underwent retrospective audit. Cases of posterior fossa ICH, subarachnoid hemorrhage, coagulopathy, tumor, or pregnancy were excluded. CT scans obtained on remaining cases of spontaneous ICH were analyzed for rebleed. Results: At UM, 85 of 193 ICH cases qualified. Second CT in 85 cases showed rebleed in 15 (18%; 95% CI 10–27%). In-hospital mortality with rebleed was 33%. Mean time of ictus-first CT was 4 hours (median 45 min; range 0–48 hrs). Mean time of ictus-second CT confirming rebleed was 12 hours (median 4 hrs; range 45 min–120 hrs). At UK, 104 of 183 ICH cases qualified. Second CT in 40 cases showed rebleed in 5 (13%, 95% CI 4–27%). In-hospital mortality with rebleed was 60%. Mean time of ictus-first CT in the 40 patients was 4.8 hours. Second CTs in 5 patients with rebleed were completed in under 15 hours. Conclusion: Our results show rebleeding under 15 hours may increase mortality up to 60% in spontaneous ICH. Prospective study of rebleed after ICH is warranted to select best time for potential treatment.