Abstract T MP66: The Ich Score: A Self-fulfilling Prophecy?
Introduction: Spontaneous intracerebral hemorrhage (ICH) remains one of the most disabling forms of stroke. Of the prognostication models developed to aid in treatment decisions, the ICH score remains the most widely used. We hypothesize that patients with higher scores that carry a poor prognosis receive less aggressive treatment based on their expected mortality and that actual mortality rates are lower than those predicted by the ICH score.
Materials and Methods: A retrospective analysis of 362 patients with spontaneous ICH from 2010-2013 was reviewed. ICH was due to hypertension, amyloid angiopathy, or was coagulopathy-induced. Surgical intervention was at the discretion of the treating neurosurgeon. Aggressive medical management was provided regardless of surgical intervention. 30-day mortality rates are reported.
Results: Of the 362 patients, mortality rates based on the original ICH score were 0%, 5%, 33%, 61%, 70%, and 91%, for ICH scores of 0-5, respectively. EVD placement rates amongst groups were 3%, 18%, 46%, 58%, 21%, and 9% in scores of 0-5, respectively and significantly different between scores of 3 and 4 (p<0.001). Median modified Graeb scores, used to estimate IVH volume, were 0, 1, 5, 14, 11, and 17 in the same groups, with no difference between scores of 3 and 4. When comparing patients with ICH scores of 3 and 4, the percentages of patients with IVH were 86% and 98% (p=0.048), rates of cerebellar hemorrhage were 3% vs. 26% (p<0.001), ICH volumes were 44 cm3 vs. 49 cm3 (p=0.030), and median GCS scores were 7 vs. 4 (p<0.001), respectively. Between both groups, there was no difference in age, rate of brainstem hemorrhages, rate of surgical intervention, 30-day mortality, or time to death in patients in whom care was withdrawn vs. those who progressed to natural death.
Conclusion: Our observed mortality rate in patients with poor prognosis ICH scores was lower than the historically quoted 97% and 99%, respectively. Higher IVH scores, ICH volumes, and cerebellar hemorrhage were not associated with increased rates of surgical intervention suggesting less aggressive treatment goals based on historical mortality rates. Scoring systems must be updated to allow for accurate prognostication and more aggressive treatment strategies.
Author Disclosures: D.J. McCracken: None. B.P. Lovasik: None. M.E. McDougal: None. C.E. McCracken: None. G. Pradilla: None.
- © 2015 by American Heart Association, Inc.