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Prediction of functional outcome in patients with primary intracerebral hemorrhage by clinical-computed tomographic
Mohammad Yousuf Rathor1, Mohammad Fauzi Abdul Rani, A R Jamalludin
1Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Malaysia.
Insights
Predictors of survival and neurological recovery in primary intracerebral hemorrhage (PICH) patients were identified. Initial CT scan findings and Glasgow Coma Scale (GCS) scores strongly correlate with patient outcomes.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Primary intracerebral hemorrhage (PICH) is a severe form of stroke with high mortality and disability.
- Predicting survival and neurological recovery in PICH patients is crucial for effective management.
Purpose of the Study:
- To identify clinical and computed tomographic (CT) predictors of survival and neurological recovery in PICH patients.
- To correlate initial patient data and CT findings with functional outcomes.
Main Methods:
- A prospective study involving 160 adult PICH patients.
- Clinical data and CT scans were analyzed and correlated with modified Rankin Scale (mRS) scores at discharge and 6-month follow-up.
Main Results:
- Higher Glasgow Coma Scale (GCS) scores were associated with better survival.
- Basal ganglia/internal capsule hemorrhage and smaller hematoma volumes (<30 ml) predicted better outcomes.
- Independent predictors of in-hospital survival included GCS > 9, basal ganglia/internal capsule location, hematoma volume <30 ml, absence of midline shift, and no intraventricular hemorrhage.
Conclusions:
- Initial CT findings and GCS scores are significant predictors of outcome and functional status in PICH patients.
- These predictors can aid in prognostication and treatment planning for intracerebral hemorrhage.
Background:
Primary intracerebral hemorrhage (PICH) remains the deadliest and most disabling form of stroke. The aim of our study was to determine the potential predictors for survival and neurological recovery in PICH patients by clinical-computed tomographic (CT) correlation.
Materials And Methods:
A prospective study conducted among PICH patients at a tertiary care hospital. The clinical and CT scan findings were correlated with the functional outcome using modified Rankin scores (mRS) of 0-5 at discharge and during six months follow-up.
Results:
The clinical and CT findings in 160 (93 male and 67 female) eligible adult patients with age range from 25 to 85 years (mean age 58.30 ± 11.44 years) were analyzed. The mean Glasgow Coma Scale [GCS] score was significantly higher among survivors. (12.8 ± 0.4 vs. 8.5 ± 0.5, P < 0.001) Based upon the pattern of the CT findings, the best outcome in terms of survival was for the patients with ICH in basal ganglia/internal capsule region (86.7 %), followed by lobar hemorrhage (67.1%). Good functional outcome was associated with a hematoma volume of less than 30 ml. At discharge majority of the survivors were functionally dependent 76 (70.4%) and only 32 (29.6%) achieved functional independence. The significant independent predictors of in- hospital survival were GCS score > 9 (OR 10.8; 95% CI 4.061 to 28.719), basal ganglia/internal capsule bleed (OR 9.750; 95% CI 2.122 to 45.004), hematoma volume <30 ml (OR 11.476; 95% CI 4. 810 to 27.434), no mid line shift (OR 4.901; 95% CI 2.405 to 9.987) and no intraventricular extension of hemorrhage (OR 7.040; 95% CI 3.358 to 14.458).
Conclusion:
Outcome and functional status at discharge were well correlated with the initial CT scan findings and GCS score.
