OUTCOME PREDICTORS AND SPECTRUM OF TREATMENT ELIGIBILITY WITH PROSPECTIVE PROTOCOLIZED MANAGEMENT OF INTRACEREBRAL HEMORRHAGE

Author:

Jaffe Jennifer1,AlKhawam Lora1,Du Hongyan2,Tobin Kristen1,O'Leary Judith1,Pollock Glen3,Batjer H. Hunt3,Awad Issam A.13

Affiliation:

1. Hemorrhagic Stroke Project, Surgical Research Office and Division of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois

2. Center for Outcomes Research and Education, NorthShore University HealthSystem, Evanston, Illinois

3. Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Abstract

Abstract OBJECTIVE Risk predictors, spectrum of treatment eligibility, and range of expected outcomes have not been validated in consecutive series including all cases of intracerebral hemorrhage (ICH) subjected to a prospective management protocol based on current guidelines. METHODS Eighty-six cases of ICH were prospectively identified in conjunction with screening for a clinical trial during an 18-month period. All patients were subjected to protocolized management based on published “best practice” guidelines for ICH. Medical records were reviewed by trained researchers, and outcomes were assessed at various time points including latest follow-up (range, 0–24 months; mean, 3.97 months). Initial assessment parameters, treatment eligibility, and outcomes were based on standardized criteria. RESULTS In accordance with past literature, mortality and functional outcomes were significantly worse in older patients, those with a larger ICH volume, and worse Glasgow Coma Scale scores, in univariate and multivariate models. The presence and severity of associated intraventricular hemorrhage also correlated with mortality and outcome. Significantly lower mortality (P = 0.024) and better functional outcomes (P = 0.018) were achieved at 30 days in patients with an ICH volume of less than 30 cm3 in this series than in previously published community-based historical controls without protocolized care. A tight correspondence between treatment eligibility and treatment administered was found. CONCLUSION Previous estimates of poorer outcome in patients with ICH might not apply to contemporary management protocols, especially in patients with a smaller ICH volume. Outcome ranges in various risk categories and modeling of treatment eligibility will help project more realistic prognostication and assist with the design of future trials.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

Reference57 articles.

1. Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus;Adams;Neurology,1998

2. Intraventricular hemorrhage among patients with recently ruptured aneurysms: A report of the Cooperative Aneurysm Study;Adams;Stroke,1992

3. Recommendations for the establishment of primary stroke centers;Alberts;JAMA,2000

4. Brain Attack Coalition: Recommendations for comprehensive stroke centers: A consensus statement from the Brain Attack Coalition;Alberts;Stroke,2005

5. A prospective study of acute cerebrovascular disease in the community: The Oxfordshire community stroke project—1981–86;Bamford;2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry,1990

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