Author(s):
Behrouz, Reza ; Misra, Vivek ; Godoy, Daniel A. ; Topel, Christopher H. ; Masotti, Luca ; Klijn, Catharina J. M. ; Smith, Craig J. ; Parry-Jones, Adrian R. ; Slevin, Mark A. ; Silver, Brian ; Willey, Joshua Z. ; Masjuan Vallejo, Jaime ; Nzwalo, Hipólito ; Popa-Wagner, Aurel ; Malek, Ali R. ; Hafeez, Shaheryar ; Di Napoli, Mario
Date: 2017
Persistent ID: http://hdl.handle.net/10400.1/13095
Origin: Sapientia - Universidade do Algarve
Subject(s): Hemorrhage; Mortality; Volume; Predictors; Growth; Stroke; Scale; Score
Description
Background and Purpose: Intracerebral hemorrhage (ICH) volume, particularly if >= 30 mL, is a major determinant of poor outcome. We used a multinational ICH data registry to study the characteristics, course, and outcomes of supratentorial hematomas with volumes <30 mL. Methods: Basic characteristics, clinical and radiological course, and 30-day outcomes of these patients were recorded. Outcomes were categorized as early neurological deterioration (END), hematoma expansion, Glasgow Outcome Scale (GOS), and in-hospital death. Poor outcome was defined as composite of in-hospital death and severe disability (GOS = 3). Comparison was conducted based on hemorrhage location. Logistic regression using dichotomized outcome scales was applied to determine predictors of poor outcome. Results: Among 375 cases of supratentorial ICH with volumes <30 mL, expansion and END rates were 19.2% and 7.5%, respectively. Hemorrhage growth was independently associated with END (odds ratio: 28.7, 95% confidence interval [CI]: 8.51-96.5; P < .0001). Expansion rates did not differ according to ICH location. Overall, 13.9% (exact binomial 95% CI: 10.5-17.8) died in the hospital and 29.1% (CI: 24.5-34.0) had severe disability at 30 days; there was a cumulative poor outcome rate of 42.9% (CI: 37.9-48.1). Age, admission Glasgow Coma Scale, intraventricular extension, and END were independently associated with poor outcome. There was no difference in poor outcome rates between lobar and deep locations (40.2% versus 43.8%, P = .56). Conclusion: Patients with supratentorial ICH <30 mL have high rates of poor outcome at 30 days, regardless of location. Nearly 1 in 5 hematomas <30 mL expands, leading to END or death.
