Study Of ICH Score At 24-Hour Of Hospitalisation as a Predictor Of Mortality In Intracerebral Hemorrhage

Introduction: Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes and remains without any treatment of proven benefit.No standard clinical grading scale for ICH analogous to those for traumatic brain injury, subarachnoid hemorrhage, or ischemic stroke.The intracerebral hemorrhage (ICH) score was developed as a predictive tool for mortality at 30 days after hemorrhagicstroke.The utility of using a predictive scoring system at 24-hours instead of on admission to predict outcomes increases the predictive value of the scoring system.Aims & Objectives:To see if ICH score calculated 24-hours after admission is a better predictor of in-hospital and 30-day mortality than ICH-score calculated on admission.Materials & Methods:In this prospective observational study carried out at tertiary care center from central India, total 161 cases of Haemorrhagic stroke proven on CT Brain fulfilling inclusion & exclusion criteria were enrolled Initial ICH score was calculated based on CT-Head and GCS score on admission.Repeat ICH score was calculated using follow up imaging and GCS score at 24 hours (+) 6 hours.CT angiography was done, 24 hours after presentation, to see for the presence of spot sign and its presence or absence was correlated with the hematoma expansion and functional outcome.CT head on admission Follow up CT Head at 24 + 6 hours after admission. CT Angiography at 24 + 6 hours after admission.Results:Mean age of the cases was 53.29 +10.94in males & 52.96 +9.45 in females with M:F 4.3:1. Maximum number of cases were falling in Moderate GCS score (9-12) 65(40.37%) 46(28.3%) cases were having severe GCS score (3-8) 82 (50.93%) patients had an ICH score of 2 at presentation. While the ICH score of maximum patients at the end of 24 hours was 0.56 (34.78%) patients had an ICH score of 0 at 24 hours after hospitalisation. The change in ICH score during the first 24 hours of hospitalisation was highly significant with a p-value of 0.0087.Based on the mRS score, 34 (21.12%) patients had a poor in-hospital functional outcome, while 37 (25.34%) patients had a poor 30-day functional outcome.The on-admission ICH score was significantly associated with both, the in-hospital and 30-day functional outcome as suggested by the p-value which was <0.0001 for both. Higher the on-admission ICH score, the poorer was the functional outcome.On comparing the on-admission and 24-hour ICH score as a predictor of poor functional outcome, the 24-hour ICH score had an RR of 1.71 and 2.69 respectively for having a poor in-hospital and 30-day functional outcome. While the RR with on-admission ICH score was 1.54 and 1.42 respectively for having a poor in-hospital and 30-day functional outcome. This data was suggestive that the 24-hour ICH score was a better predictor of in-hospital and 30-day mortality when compared to the on-admission ICH score. The presence of spot sign on CT angiography was associated with a poor ICH score and functional outcome. Of the 12 patients with positive spot sign on CT angiography, all 12 (100%) had a poor ICH score (>1), while 9 (75%) had a poor functional outcome.Multivariate analysis was suggestive that the GCS score was the single most significant factor affecting the ICH score as well as the outcome of patients with ICH.Conclusion: 1.The 24-hour ICH score is a valid predictor of in-hospital and 30-day mortality and functional outcome in patients with intracerebral hemorrhage.2.The 24-hour ICH score is a better predictor of mortality than on-admission ICH score in patients with intracerebral hemorrhage.3.The presence of ‘spot sign’ correlated well with a poor ICH score