Primary Pontine Hemorrhage in the Acute Stage: Clinical Features and a Proposed New Simple Scoring System

Meguro, Toshinari; Kuwahara, Ken; Tomita, Yusuke; Okuma, Yu; Tanabe, Tomoyuki; Muraoka, Kenichiro; Terada, Kinya; Hirotsune, Nobuyuki; Nishino, Shigeki

doi:10.1016/j.jstrokecerebrovasdis.2014.12.006

Cited by 25 publications

(40 citation statements)

References 27 publications

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“…26 An earlier scale incorporated three factors for predicting 30-day mortality: admission GCS score 6, absence of pupillary light reflex, and serum glucose !180 -each assigned 1 point. 23 The number of patients in that study was 101. 23 Thirty-day mortality rates were 7.7%, 33.3%, 78.9% and 100% for patients with 0, 1, 2 and 3 points, respectively.…”

Section: Clinical Factorsmentioning

confidence: 99%

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Prognostic factors in pontine haemorrhage: A systematic review

Behrouz

2018

European Stroke Journal

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Background: Pontine haemorrhage comprises approximately 10% of intracerebral haemorrhages. There is a common presumption that pontine haemorrhage is inherently associated with poor outcome. Purpose: The aim of the review was to identify chief predictors of prognosis in (pontine haemorrhage) through systematic review of published literature. Methods: A query of PubMed/MEDLINE was conducted in search of studies in English language since, 1980 focusing specifically on outcome in pontine haemorrhage. References for each publication were reviewed for additional studies not detected by the PubMed/MEDLINE probe. Surgical outcome studies were excluded from the review. Findings: The query identified 7867 titles, after removal of duplicates and irrelevant studies, 20 titles were included in the review. In a total of 1437 pontine haemorrhage patients included in the 20 studies, the overall rate for early all-cause mortality was 48.1%. Level of consciousness on admission and haemorrhage size were the most consistent predictors of mortality in patients with pontine haemorrhage. Haemorrhage localisation within the pons was also a prognostic factor, but not consistently. Age and intraventricular extension were not found to be powerful prognostic predictors. Discussion/Conclusion: Based on this review, level of consciousness on admission and haemorrhage size were the most influential prognostic factors in pontine haemorrhage, whereas age, haemorrhage localisation, and intraventricular haemorrhage did not consistently predict prognosis.

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Section: Clinical Factorsmentioning

confidence: 99%

“…23 The number of patients in that study was 101. 23 Thirty-day mortality rates were 7.7%, 33.3%, 78.9% and 100% for patients with 0, 1, 2 and 3 points, respectively. 23 With regard to this scale, PH volume was dichotomised into <20 and !20 mL, which may be too high of a volume threshold for the finite size of the pons.…”

Section: Clinical Factorsmentioning

confidence: 99%

Prognostic factors in pontine haemorrhage: A systematic review

Behrouz

2018

European Stroke Journal

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“…13 Researchers from Japan have tried to establish a grading scale (PPH score) for PPH patients. 14 However, in their model, continuous variables such as GCS and hematoma volume were predefined as binary variables, which may have influence on independent factor screening. In addition, the PPH score lacks external validation.…”

Section: Strokementioning

confidence: 99%

“…Factors that showed significance in univariate analysis were drawn into stepwise, forward logistic regression to identify their independent association with 30-day mortality. Cutoff points of the variables were determined by receiver operating characteristic curve analysis, and certain points were assigned to these predictors to produce a simple and intuitive grading scale, named the new PPH score (for differentiation from the previous PPH score 14 ).…”

Section: Development Of the New Pph Scorementioning

confidence: 99%

“…Thus, we stratified both the GCS and PPH volume into 3 scales according to prior studies and our own findings. [4][5][6]14 From our observation, patients with PPH volume <5 mL had a big chance to survive, whereas those with PPH volume >10 mL tended to die at early stage. For PPH volumes between 5 and 10 mL, patients with GCS score of 3 to 4 were highly fatal, whereas those with GCS score of 8 to 15 were more likely to experience functional recovery than those with a score of 5 to 7.…”

Section: Strokementioning

confidence: 99%

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Development and Validation of a Grading Scale for Primary Pontine Hemorrhage

Huang

Zhong

Sun

et al. 2017

Stroke

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P rimary pontine hemorrhage (PPH) is the most devastating type of intracranial hemorrhage (ICH), with an acute mortality ranging from 30% to 60%. [1][2][3] Various factors including coma at admission, location, and volume of the hematoma were found to associate with these diverse outcomes. However, inconsistent predictors were reported when different parameters and populations were brought into analysis. [4][5][6][7] As a corollary, it would make cogent sense by combining significant factors into a grading scale to enhance predictive power and, meanwhile, provide a useful tool for physicians in decision-making when facing such patients. 8 Currently, there is no standard, widely accepted early prognostic model or clinical grading scale for outcome prediction in PPH patients. The ICH score, composed of age, Glasgow Coma Scale (GCS), infratentorial origin, intraventricular hemorrhage, and hemorrhage volume, has been widely validated in predicting acute mortality, as well as long-term functional outcome in spontaneous ICH.9,10 Easy to use though, the ICH score and its derivatives tended to deem infratentorial hemorrhage as an independent predictor of poor outcome. 11,12 Because of the small structure of the pons but severe manifestations caused by hemorrhagic impairment, the cutoff value Background and Purpose-We aimed to develop and validate a grading scale for predicting 30-day mortality and 90-day functional outcome in patients with primary pontine hemorrhage (PPH). Methods-We retrospectively reviewed records of consecutive patients with first-ever pontine hemorrhage from 3 teaching hospitals between 2005 and 2012. Independent factors associated with 30-day mortality were identified by logistic regression to establish a risk stratification scale, named the new PPH score. For validation of the new PPH score, we prospectively recruited subjects from 10 units between December 2014 and November 2015. The performance of the new PPH score was presented as discrimination and calibration, measured by area under the curve of the receiver operating characteristic and Hosmer-Lemeshow goodness-of-fit, respectively. Results-Data of 171 patients were available for scale development. The new PPH score consisted of 2 independent factors with individual points assigned as follows: Glasgow Coma Scale score 3 to 4 (=2 points), 5 to 7 (=1 point), and 8 to 15 (=0 point); PPH volume >10 mL (=2 points), 5 to 10 mL (=1 point), and <5 mL (=0 point). An independent cohort of 98 patients was applied as an external validation of the new PPH score. Results showed that the new PPH score was discriminative in predicting both 30-day mortality (area under the curve, 0.902) and 90-day good outcome (area under the curve, 0.927). Furthermore, the new PPH score revealed a good calibration (χ 2 =1.387; P=0.846) in 30-day mortality prediction. Conclusions-The

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