The Intracerebral Hemorrhage Score: Changing Perspectives on Mortality and Disability

• Published in: World neurosurgery 2020-03, Vol.135, p.e573-e579
• Main Authors: Garton, Andrew L.A., Gupta, Vivek P., Sudesh, Saurabh, Zhou, Henry, Christophe, Brandon R., Connolly, E. Sander
• Format: Article
• Language: English
• Subjects: Cerebral Hemorrhage - mortality; Cerebral Hemorrhage - surgery; Disability; Disabled Persons - statistics & numerical data; Female; Functional outcomes; Glasgow Coma Scale - statistics & numerical data; Humans; ICH Score; Intracerebral hemorrhage; Male; Middle Aged; Mortality; Prognosis; Prospective Studies; Surgery; Withdrawal of care; Withholding Treatment - statistics & numerical data
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.12.074

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. 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. 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. Though the original ICH Score overestimates mortality for low-grade and moderate-grade hemorrhages, it may underpredict severe disability.