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CT imaging for long-term functional outcome after spontaneous intracerebral haemorrhage: A 3-year follow-up study
Shadi Asadollahi1,2, Ali Vafaei3, Kamran Heidari3
1a School of Medicine.
Insights
Head CT scans predict outcomes for Spontaneous Intracranial Hemorrhage (SICH) patients. Larger hematoma volume, intraventricular hemorrhage, and midline shift indicate poorer prognosis for survival and functional recovery at 3 years.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
- Critical Care Medicine
Background:
- Spontaneous Intracranial Hemorrhage (SICH) is a critical condition with significant mortality and morbidity.
- Early prognostic indicators are crucial for guiding clinical management and patient counseling.
- The role of initial head computed tomography (CT) findings in predicting long-term outcomes requires further definition.
Purpose of the Study:
- To determine the prognostic value of head CT scans in patients with SICH.
- To assess the predictive capability of CT findings for 30-day mortality and long-term functional outcomes at 36 months.
Main Methods:
- Prospective inclusion of 228 SICH patients who underwent brain CT within 12 hours of presentation.
- Univariable and multivariable regression analyses were employed to identify independent predictors.
- Outcomes assessed included 30-day mortality and unfavorable functional status (modified Rankin Scale = 4-6, Barthel Index ≤ 60) at 36 months.
Main Results:
- Independent CT predictors for 30-day mortality included intraventricular hemorrhage (IVH), hematoma volume ≥ 30 cm³, midline shift, and hydrocephalus.
- Significant associations with unfavorable functional outcome (mRS ≥ 4 at 36 months) were found for IVH, hematoma volume ≥ 30 cm³, and midline shift.
- Odds ratios indicated substantial increased risk for mortality and poor functional outcome with these CT findings.
Conclusions:
- Head CT findings, specifically IVH, larger hematoma volume, and midline shift, are significant predictors of poor long-term functional outcome in SICH patients.
- These CT markers also correlate with reduced short-term survival.
- Initial head CT provides valuable prognostic information for SICH patients, aiding in predicting both survival and functional recovery.
Primary Objective:
To define the prognostic value of head computed tomography (CT) in patients suffering from SICH after 3 years of follow-up.
Research Design And Methods:
Between January 2011 and May 2012, consecutive patients with SICH who underwent brain CT scans within the first 12 hours of presentation were prospectively included. Independent predictors of 30-day mortality and unfavourable functional outcome (modified Rankin Scale = 4-6 and Barthel Index ≤ 60) at 36 months were identified by univariable and multivariable regression analysis.
Main Outcomes And Results:
A total of 228 participants were identified. According to multivariable analysis, independent CT-related predictors for 30-day mortality were intraventricular haemorrhage [IVH] (OR = 2.42; p = 0.009), haematoma volume ≥ 30 cm3 (OR = 3.32; p = 0.006), the presence of midline shift (OR = 3.77; p = 0.004) and hydrocephalus (OR = 5.22; p = 0.001). Further, IVH (OR = 3.72, 95% CI = 1.16-11.8, p = 0.026), volume of haemorrhage ≥ 30 cm3 (OR = 3.96; 95% CI = 1.65-5.84; p = 0.015) and midline shift (OR = 6.58; 95% CI = 1.33-32.4; p = 0.021) had significant associations with an mRS ≥ 4 at 36 months.
Conclusions:
A favourable long-term functional outcome at 36 months and short-term survival were less likely in patients with greater volume of haematoma, presence of IVH and midline displacement.
