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Published on: October 15, 2021
The Intracerebral Hemorrhage Score: Changing Perspectives on Mortality and Disability
Andrew L A Garton1, Vivek P Gupta2, Saurabh Sudesh3
1Department of Neurosurgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New, York, USA.
Insights
The Intracerebral Hemorrhage (ICH) Score may overestimate survival for low-grade bleeds but underpredicts severe disability. Redefining poor outcomes to include severe disability reveals higher rates for ICH Score 2 patients.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Intracerebral hemorrhage (ICH) is a severe neurological condition with significant mortality.
- The ICH Score is a clinical tool for prognostication, but management advances have altered outcomes.
- Contemporary data is needed to reassess the ICH Score's accuracy in predicting outcomes.
Purpose of the Study:
- To evaluate mortality rates across ICH Score strata.
- To determine if the ICH Score accurately predicts poor outcomes when severe disability is included.
- To compare current findings with historical and contemporary cohorts.
Main Methods:
- Analysis of a single-institution cohort (2009-2016) of 582 ICH patients.
- Stratification of mortality and poor outcomes (death or modified Rankin Scale score ≥5) by ICH Score.
- Comparison with historical and contemporary datasets.
Main Results:
- Mortality rates were lower than expected for low- and moderate-grade ICH.
- When severe disability was included in poor outcomes, rates were higher for ICH Score 2 (51.16% vs. 26%, P=0.017).
- No significant difference in poor outcome rates for other ICH Score groups compared to historical data.
Conclusions:
- The ICH Score overestimates survival in low- and moderate-grade ICH.
- The ICH Score may underpredict the risk of severe disability, particularly for patients with an ICH Score of 2.
- Revising outcome definitions may be necessary for accurate prognostication in ICH.
Background:
Intracerebral hemorrhage (ICH) remains a devastating diagnosis. While the ICH Score continues to be used in the clinical setting to prognosticate outcomes, contemporary improvements in management have reduced mortality rates for each scoring tier. The aims of this study were to examine mortality rates within ICH Score strata and examine if these findings are stable when major disability is included in categorizing poor outcomes.
Methods:
From a single-institution cohort built between 2009 and 2016, 582 patients were extracted based on the criteria for complete ICH Score, discharge mortality, and functional status for survivors. Mortality rates were stratified by ICH Score and compared with both historical and similar contemporary cohorts. Poor outcome was defined as severe disability (modified Rankin Scale score 5) in addition to death, stratified by ICH Score, and compared. A secondary analysis of patients with ICH Score of 2 was performed in light of the primary results.
Results:
Mortality rates stratified by ICH Score were notably lower than expected for low- and moderate-grade ICH compared with the original cohort. However, when defining a poor outcome as including severe disability (modified Rankin Scale score 5) in addition to death, the rates for poor outcomes were higher for patients with ICH Score of 2 (51.16% vs. 26%, P = 0.017) and no different for any other score group compared with the original cohort.
Conclusions:
Though the original ICH Score overestimates mortality for low-grade and moderate-grade hemorrhages, it may underpredict severe disability.
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