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Early presentation of hemispheric intracerebral hemorrhage: prediction of outcome and guidelines for treatment allocation
- Source :
- Neurology. 44(1)
- Publication Year :
- 1994
-
Abstract
- Criteria for selecting patients for possible surgery in the management of intracerebral hemorrhage (ICH) are needed to plan a prospective therapeutic evaluation of surgical intervention. This study specifically addressed patients seen in the emergency room within a few hours of the ictus, many of whom were still awake, to identify and subsequently exclude from surgical procedure those expected to recover completely and those expected to die regardless of treatment. We retrospectively studied 75 patients evaluated at a mean time of 3 hours and 37 minutes after hemispheric ICH to determine factors that would predict both good and poor outcomes at the time of discharge. Eighty percent of our patients presented within 6 hours of symptom onset. These patients were younger and had more severe lesions than did those presenting later, yet most were still awake (mean admission Glasgow Coma Scale [GCS] score = 11.0). Using multivariate regression, we created two models. The first model predicts independent outcome, ie, Rankin 0 to 2, of all patients with a GCS score greater than 9 on admission who do not undergo surgery. The significant factors in this model were hemorrhage diameter, intraventricular extension, and age. The second model predicts poor outcome, ie, Rankin 5 and death, of all patients. GCS score, hemorrhage volume, age, and gender were the important factors in this model. We conclude that ICH patients presenting early to the emergency room have more severe lesions radiologically, although their initial clinical status may not be different from those seen late. Our models should identify and thus exclude those with very good and very poor prognoses from future randomized surgical trials.
- Subjects :
- Adult
Male
medicine.medical_specialty
Pediatrics
Emergency Medical Services
Multivariate analysis
Time Factors
Guidelines as Topic
Central nervous system disease
medicine
Emergency medical services
Humans
Glasgow Coma Scale
Aged
Cerebral Hemorrhage
Retrospective Studies
Intracerebral hemorrhage
Aged, 80 and over
Vascular disease
business.industry
Retrospective cohort study
Middle Aged
Models, Theoretical
medicine.disease
Surgery
Treatment Outcome
Multivariate Analysis
Regression Analysis
Female
Neurology (clinical)
Presentation (obstetrics)
business
Forecasting
Subjects
Details
- ISSN :
- 00283878
- Volume :
- 44
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Neurology
- Accession number :
- edsair.doi.dedup.....620c936646e21eadb57fe8fee8a5d70c