Combination Intracerebral Hemorrhage- Graeb Score Improves Prediction of Outcome in Spontaneous Intracerebral Hemorrhage
Niryana Wayan1, Saputra Anne2 and Mahadewa Tjokorda11Department of Neurosurgery, Medical Faculty, Udayana University, Sanglah General Hospital, Bali, Indonesia.
2Department of Surgery, Medical Faculty, Udayana University, Sanglah General Hospital, Bali, Indonesia.
Corresponding Author E-mail: tjokmahadewa@unud.ac.id
Abstract: Intraventricular extension of intracerebral hemorrhage (IVH) is an poor independent outcome predictor in spontaneous intracerebral hemorrhage (ICH). IVH volume important in prediction of outcome and management; however, it is hard to measure routinely. Large IVH volume and increased number of affected ventricles have been associated with worse prognosis. Easy-to-use ICH scoring systems inform physicians of the severity and help to decide the course of management. ICH scoring system used to translate the severity into a score, allows quantification of severity, to predict outcome and clinical research. Graeb score can estimate the probability of survival in IVH volume. Purpose of this study is to combine original ICH score and Graeb score, to predict outcome in patients spontaneous ICH and determined the combination would improve the prediction.This prospective observational study of 88 patients who demonstrated spontaneous ICH with and without IVH on initial brain computed tomography (CT) were enrolled at Sanglah General Hospital Denpasar throughout 2017. Independent mortality or good outcome evaluation disability using modified Rankin Scale (mRS) at 30 days. Combination ICH-Graeb score was created by adding Graeb Score into original ICH. Mortality rate was 53.4%, and 34% has good outcome. Statistical result in terms of predictive power ICH score for in-hospital unfavourable outcome with cutoff point ³3 {Area Under Curve (AUC): 0.7546} risk ratio 1.8 (Confidence Interval/CI 95%: 1.29-2.67; p=0.0002). While predictive power Graeb score for in-hospital unfavourable outcome with cutoff point ³1 (AUC: 0.6365) risk ratio 1.7 (Confidence Interval/CI 95%: 1.11-2.61; p=0.0034). Combined ICH and Graeb score risk ratio 1.9 (Confidence Interval/CI 95%: 1.16-3.14; p=0.0012). The combination ICH-Graeb score better tools for prediction of unfavourable outcome. Combination of ICH and Graeb score improves the prediction of outcome in spontaneous ICH. Provides as accurate, simple, applicable and reliable screening tools.
Keywords: Intraventricular Hemorrhage; Outcome; Prognosis; Spontaneous Intracerebral Hemorrhage Back to TOC