Validation and comparison of models predicting survival following intracerebral hemorrhage

Tuhrim, Stanley; Horowitz, Deborah R.; Sacher, Michael; Godbold, James

doi:10.1097/00003246-199505000-00026

Cited by 138 publications

(76 citation statements)

References 27 publications

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“…Prognostic models for outcome in patients with ICH most frequently include the initial hematoma size as assessed on NCCT in addition to clinical variables such as the GCS score, which have been found to be significant independent predictors of mortality in multiple studies. 13,[20][21][22] The present study demonstrated that the addition of intravenous contrast in the setting of acute ICH, usually performed to assess an underlying cause or substrate of hemorrhage, can provide useful information about the risk of hematoma expansion in acute ICH. This is in agreement with the recent study by Goldstein et al 15 Also, contrast extravasation on CTA/CECT independently predicted hospital mortality and 30-day mortality.…”

Section: Discussionmentioning

confidence: 67%

Contrast Extravasation on CT Predicts Mortality in Primary Intracerebral Hemorrhage

Kim¹,

Smith²,

Hemphill³

et al. 2007

AJNR Am J Neuroradiol

155

117

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BACKGROUND AND PURPOSE:Recent studies of intracerebral hemorrhage (ICH) treatments have highlighted the need to identify reliable predictors of hematoma expansion. The goal of this study was to determine whether contrast extravasation on multisection CT angiography (CTA) and/or contrastenhanced CT (CECT) of the brain is associated with hematoma expansion and increased mortality in patients with primary ICH.

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Section: Discussionmentioning

confidence: 67%

Contrast Extravasation on CT Predicts Mortality in Primary Intracerebral Hemorrhage

Kim¹,

Smith²,

Hemphill³

et al. 2007

AJNR Am J Neuroradiol

155

117

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“…I ntraventricular hemorrhage (IVH) secondary to spontaneous intracerebral hemorrhage (ICH) results in death in 32% to 43% of cases [1][2][3][4][5][6][7][8] and poor functional outcome in most survivors. 5,7,[9][10][11][12][13][14][15] In severe IVH with obstruction of the third or fourth ventricle, the placement of an extraventricular drain can help lower raised intracranial pressure.…”

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confidence: 99%

The Modified Graeb Score

Morgan

Dawson

Spengler

et al. 2013

Stroke

137

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Background and Purpose-Simple and rapid measures of intraventricular hemorrhage (IVH) volume are lacking. We developed and validated a modification of the original Graeb scale to facilitate rapid assessment of IVH over time. Methods-We explored the relationship between the modified Graeb scale (mGS), original Graeb scale, measured IVH volume, and outcome using data from the Clot Lysis: Evaluating Accelerated Resolution of Hemorrhage with rtPA B (CLEAR B) study. We also explored its reliability. We then evaluated the relationship between mGS and outcome in a large sample of participants with IVH using data contained within the Virtual International Stroke Trials Archive (VISTA). We defined outcome using the modified Rankin scale (>3 signifying poor outcome). Results-The CLEAR B study included 360 scans from 36 subjects. The mGS score and IVH volume were highly correlated (R = 0.80, P<0.0001, R 2 0.65). Baseline mGS was predictive of poor outcome (area under receiving operating characteristic curve 0.74, 95% confidence interval, 0.57-0.91), whereas the original Graeb scale was not. The VISTA study included 399 participants. Each unit increase in the mGS led to a 12% increase in the odds of a poor outcome (odds ratio, 1.12; 95% confidence interval, 1.05-1.19). Measures of reliability (intra-and inter-reader) were good in both studies. Conclusions-The

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“…8,20,35 Previous neurosurgical studies have also demonstrated age-dependent morbidity and mortality rates, with younger patients faring better than older patients undergoing craniotomy for intracranial bleeding. 13,35 However, current advances in imaging, rapid diagnostics, medical management of hemodynamic properties, and surgical techniques have improved patient outcomes, 36 and a further decrease in mortality associated with treatment for intracranial bleeding has been demonstrated; in 2008, postoperative mortality associated with craniotomy for evacuation of acute subdural and epidural hematoma ranged from 22% to 41%. 17,33,34 It is plausible that this overall decrease in mortality may also be reflected by improved survival among older patients.…”

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confidence: 99%

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

Lau

El-Sayed

Ziewacz

et al. 2012

JNS

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Object Advances in the management of trauma-induced intracranial hematomas and hemorrhage (epidural, subdural, and intraparenchymal hemorrhage) have improved survival in these conditions over the last several decades. However, there is a paucity of research investigating the relation between patient age and outcomes of surgical treatment for these conditions. In this study, the authors examined the relation between patient age over 80 years and postoperative outcomes following closed head injury and craniotomy for intracranial hemorrhage. Methods A consecutive population of patients undergoing emergent craniotomy for evacuation of intracranial hematoma following closed head trauma between 2006 and 2009 was identified. Using multivariable logistic regression models, the authors assessed the relation between age (> 80 vs ≤ 80 years) and postoperative complications, intensive care unit stay, hospital stay, morbidity, and mortality. Results Of 103 patients, 27 were older than 80 years and 76 patients were 80 years of age or younger. Older age was associated with longer length of hospital stay (p = 0.014), a higher rate of complications (OR 5.74, 95% CI 1.29–25.34), and a higher likelihood of requiring rehabilitation (OR 3.28, 95% CI 1.13–9.74). However, there were no statistically significant differences between the age groups in 30-day mortality or ability to recover to functional baseline status. Conclusions The findings suggest that in comparison with younger patients, patients over 80 years of age may be similarly able to return to preinjury functional baselines but may require increased postoperative medical attention in the forms of rehabilitation and longer hospital stays. Prospective studies concerned with the relation between older age, perioperative parameters, and postoperative outcomes following craniotomy for intracranial hemorrhage are needed. Nonetheless, the findings of this study may allow for more informed decisions with respect to the care of elderly patients with intracranial hemorrhage.

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Validation and comparison of models predicting survival following intracerebral hemorrhage

Abstract: Model 1 predicts 30-day patient status as well as the more complex model 2. Model 1 provides a valid, easy-to-use means of categorizing supratentorial intracerebral hemorrhage patients in terms of their probability of survival.

Cited by 138 publications

References 27 publications

Contrast Extravasation on CT Predicts Mortality in Primary Intracerebral Hemorrhage

Contrast Extravasation on CT Predicts Mortality in Primary Intracerebral Hemorrhage

The Modified Graeb Score

Postoperative outcomes following closed head injury and craniotomy for evacuation of hematoma in patients older than 80 years

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