Journal of Neurosurgery 2002 Sep;97(3):531-
Prediction of death in patients with primary intracerebral hemorrhage: a prospective study of a defined population.
Nilsson OG, Lindgren A, Brandt L, Saveland H. from the Lund University Department of Neurosurgery.
Summary: The authors prospectively assessed those factors associated with 30 day and 1 year mortality in a population of patients with primary intracerebral hemorrhage. In the 341 cases studied, the mortality rate was 36% at 30 days and 47% at one year. Initial level of consciousness, hematoma volume, and heart disease were independent co-factors for early mortality. Age was also a factor that predicted one year mortality. 72% of those with hematoma volume greater than 60 cc were deceased at 30 days whereas 19% of those with volume of less than 30 cc were deceased at 30 days. At the one year time point both deep and lobar hemorrhages had over 40% mortality.
Commetary: This report benefits from a prospective design, multivariate statistical analysis. The emphasis on volume of hemorrhage and the level of consciousness are well warranted. Greater than 80% of those who presented in coma were dead at 30 days. What are the implications for the practicing neurosurgeon? The question of when to evacuate intracerebral hematoma remains with us and these decisions must be made rapidly. One advance would be software that would allow for segmentation and volume calculations proximate in time to the original CT scan. To be called from the emergency room regarding a 57 cc hemorrhage in the occipital pole versus a 23 cc cerebellar hemorrhage would instantly convey important information about overall prognosis. This would permit the development of clinical protocols that could be rapidly implemented for trials of minimally invasive evacuation or other therapies. In conjuction with location data, this would allow us to go beyond the gestalt of “large” or “small” hemorrhages and be more quantitative. ~Bob Carter, M.D.