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Modifying the Intracerebral Hemorrhage Score to Suit the Needs of the Developing World
1Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Insights
Intracerebral hemorrhage (ICH) outcomes in India differ from Western populations. The standard ICH score needs modification, specifically lowering the age criteria, for better mortality prediction in younger Indian patients.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Limited published data exists on intracerebral hemorrhage (ICH) in the Indian subcontinent.
- Accurate prognostication is crucial for cost-effective treatment customization in resource-constrained settings.
Purpose of the Study:
- To identify prognostic factors for intracerebral hemorrhage (ICH) outcomes.
- To validate the widely used ICH score in a South Asian population.
- To propose modifications to the ICH score for improved accuracy in this demographic.
Main Methods:
- A prospective study of 215 spontaneous intracerebral hemorrhage (ICH) patients was conducted.
- Data collected included demographics, clinical presentation, biochemical, and CT findings.
- Outcomes were assessed using the modified Rankin Scale (mRS) at discharge and three months.
Main Results:
- The mean age of the cohort was 57.64 years, with a mean bleed volume of 24.5ml.
- Factors like low Glasgow Coma Scale (GCS), intraventricular extension, and large hematoma volume correlated with higher mortality.
- The standard ICH score showed poor predictive accuracy; a modified ICH score (rICH) with a reduced age threshold showed improved, though not perfect, prognostication.
Conclusions:
- The standard ICH score is not optimal for predicting mortality in the Indian population due to demographic differences.
- Intracerebral hemorrhage (ICH) occurs in a younger demographic in India, potentially leading to better outcomes than in Western cohorts.
- A modified ICH score, adjusting the age parameter downwards, is proposed to enhance prognostic accuracy for Indian patients.
Background:
Published literature on intracerebral haemorrhage (ICH) from the Indian subcontinent is very scarce. The study aims to assess the prognostic factors influencing outcome and validating the ICH score which is widely used to prognosticate the disease in this financially constraint population. Prognosticating the outcome at the time of admission is important to customize treatment in a cost-effective manner.
Materials And Methods:
We conducted a prospective study of all Spontaneous ICH patients admitted from February 2015 to May 2016. Data pertaining to patient demographics, clinical findings, biochemical parameters and cranial computed tomography (CT) findings were recorded. mRS (modified Rankin score) was used to assess outcome at discharge and at three month follow up.
Results:
A total of 215 patients with hypertensive haemorrhage were analysed. The mean age of our cohort was 57.64 years and volume of bleed was 24.5ml. 73% pf patients with GCS<8, 46% with Intraventricular extension and 57% with hematoma volume >30 were died at the end of 3 months. Twenty eight patients succumbed during hospitalization while 38 died after their discharge. Mortality rates were 5%,16%, 33%, 54% and 93% for ICH Scores of 0, 1, 2, 3 and 4. The rICH score after modifying the age parameter in the ICH score to 70 years had mortality rates of 6%,15%,25%,51%,75% and 100%.
Conclusion:
ICH Score failed to accurately predict mortality in our cohort. ICH is predominately seen at a younger age group in our country and hence have better outcomes in comparison to the west. We propose a minor modification in the ICH score by reducing the age criteria by 10 years to prognosticate the disease better in our population.
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