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J Korean Soc Emerg Med > Volume 16(2); 2005 > Article
Journal of The Korean Society of Emergency Medicine 2005;16(2): 229-237.
Prediction of 30-day Mortality and Functional Outcome of Patients with Intracerebral Hemorrhage in Emergency Department
Hoon Kim, Suk Woo Lee
Department of Emergency Medicine, College of Medicine, Chungbuk National University, Cheongjoo, Korea. nichekh2000@hanmail.net
Stroke is the third leading cause of death in Korea, after heart disease and cancer, and it is the leading cause of disability. Intracerebral hemorrhage (ICH) is one of the common vascular insults with a relatively high rate of mortality, accounting for 10% to 15% of all strokes. More than 50% of the patients die, and half of the survivors are left severely disabled. The aim of this study is to seek excellent predictors of the 30-day mortality and the functional outcome at discharge, and to help emergency physician to explain the prognosis to the patient's family and decide whether or not to provide aggressive treatment.
We reviewed the medical records of patients with spontaneous ICH who had been admitted to the Emergency Department (ED) at Chungbuk University Hospital between January 2001 to June 2003, and we analyzed the clinical and radiological data from those patients with neuroimaging evidence of ICH. The risk factors of stroke, the neurologic assessment (Glasgow Coma Scale [GCS] and Modified Rankin's Scale at discharge) and the ICH score were documented.
The 30-day mortality rate was 31.6%. Independent factors for the 30-day mortality rate were a high ICH score, the presence of intraventricular hemorrhage, an ICH volume >or= 30 cc, a low GCS score at admission to the ED, a high systolic blood pressure, a high serum glucose level and the presence of infratentorial ICH. By using the areas under the receiver operating characteristic (AUROC) curves, We showed that the ICH score had excellent discriminative power (AUROC 0.802) and that the ICH score was superior to the ICH volume (0.744), and the GCS score (0.250).
We can use various independent predictors of the 30-day mortality rate and a poor functional outcome at discharge, including the ICH score, the presence of IVH, the GCS score, the ICH volume, the systolic blood pressure, glucose, etc. Especially, the ICH score is a simple clinical grading scale with excellent prognostic abilities and can be used to enhance clinical judgement of the prognosis and to provide patients and their families with objective information.
Key words: Intracerebral hemorrhage, Mortality, Treatment outcome
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