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Early Identification of Intracranial Hemorrhage Using a Predictive Nomogram
Frances Chandler1, Joyce Kane2, Amanda Blackford2
1Johns Hopkins Hospital.
Oncology Nursing Forum
|February 22, 2018
Summary
Hospitalized adults with hematologic malignancies experiencing prolonged activated partial thromboplastin time (APTT), elevated systolic blood pressure (SBP), and headache are at higher risk for intracranial hemorrhage (IH). Early recognition aids in timely intervention for these critical patients.
Area of Science:
- Hematology
- Neurology
- Oncology
Background:
- Intracranial hemorrhage (IH) is a serious complication in patients with hematologic malignancies.
- Identifying predictive factors for IH is crucial for early detection and management in this vulnerable population.
Purpose of the Study:
- To identify predictive signs and symptoms of intracranial hemorrhage (IH) in hospitalized adult patients with hematologic malignancies.
- To develop a prognostic nomogram for predicting IH risk.
Main Methods:
- Retrospective matched case-control study at a comprehensive cancer center.
- Included adult inpatients with hematologic malignancies with (n=39) and without (n=39) IH.
- Utilized conditional logistic regression, t tests, and Fisher's exact tests; developed a prognostic nomogram.
Main Results:
- A prognostic nomogram demonstrated good discriminative ability (concordance index = 0.766) and calibration.
- Prolonged activated partial thromboplastin time (APTT > 30.6), headache, and systolic blood pressure (SBP ≥ 140) were associated with increased IH risk.
- The nomogram effectively predicted patients at higher risk for IH.
Conclusions:
- Nurses should be vigilant for the combination of prolonged APTT, elevated SBP, and headache as indicators of potential IH in patients with hematologic malignancies.
- This predictive model can aid in early identification and intervention, potentially improving outcomes for patients at risk of intracranial hemorrhage.
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