Can we predict poor outcome at presentation in patients with lobar hemorrhage?

Kelly D. Flemming, Eelco F.M. Wijdicks, Hongzhi Li

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

Objective: Supratentorial lobar hemorrhage can be devastating. Outcome prediction at presentation is important in triage and management decisions as well as appropriate resource utilization. We performed a decision tree analysis combining clinical and CT scan features to predict poor and hopeless outcome at initial presentation in patients with lobar hemorrhage. Methods: We analyzed 81 patients with spontaneous lobar hemorrhage presenting within 48 hours of initial neurologic symptoms. In the first analysis, poor outcome was defined as Glasgow outcome score (GOS) of 1 (death), 2 (vegetative state) or 3 (dependence) at discharge. A second analysis was based on worst possible outcome (GOS 1-2). Binary recursive partitioning was fitted in a model, and odds ratios with 95% confidence intervals (CI) were calculated. Results: Lobes involved were temporal (36%), parietal (33%), frontal (25%) and occipital (6%). Seventy-three percent of patients presented less than 17 h after initial ictus. The probability of poor outcome was 97% (CI 85-100%) in patients with hemorrhage greater than 40 cm3. In the subset of patients with a volume less than 40 cm3, time interval from ictus to presentation (<17 h) together with a Glasgow coma score (GCS) less than or equal to 13 predicted poor outcome. Eighty-five percent (CI 42-99%) of those presenting early with GCS less than or equal to 13 had a poor outcome. In the second analysis, all patients with GCS less than or equal to 12 and septum pellucidum shift >6 mm had GOS of 1 or 2 (CI 72-100%). Conclusion: Poor outcome in patients with lobar hemorrhage is associated with a hemorrhage size of more than 40 cm3, GCS less than or equal to 13, but also dependent on time interval between ictus and presentation. This is consistent with prior studies demonstrating deterioration from enlargement may occur when patients present early on. Stupor and septum pellucidum shift greater than 6 mm on CT scan at presentation predict a hopeless outcome in conservatively treated patients. Ninety-one percent of patients were treated medically, thus these outcomes are largely a reflection of the natural history of spontaneous lobar hemorrhage. These signs may influence triage and management decisions.

Original languageEnglish (US)
Pages (from-to)183-189
Number of pages7
JournalCerebrovascular Diseases
Volume11
Issue number3
DOIs
StatePublished - Apr 26 2001

Keywords

  • CT scan
  • Cerebral hemorrhage
  • Death
  • Glasgow coma score
  • Outcome

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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