Spontaneous supratentorial intracerebral hemorrhage - Criteria for short-term functional outcome prediction

Background and Purpose To identify the significant prognostic factors, upon admission, and construct a set of criteria to predict short-term functional outcome of patients with intracerebral hemorrhage (ICH). Methods The records as well as the radiological findings, of 184 consecutive cases of spontaneous supratentorial intracerebral hemorrhage, that were treated medically, were reviewed. The hemorrhage was graded according to size, mass effect and intraventricular extension. Outcome upon discharge was scored using the modified Rankin Scale. A score of four or more was considered a poor outcome. Multivariate analysis was used to identify the factors associated with a poor outcome. Results Six significant and independent prognostic variables were identified: decreased level of consciousness, severe hemiparesis, age older than sixty, large hematoma size, midline shift and intraventricular extension on CT. These variables were scored systematically to produce the ICH criteria. The sum of these criteria yields a figure between zero and six termed ICH score. Patient grouping according to ICH score identified four distinctive, prognostic groups: I - score of zero to one, II - score of two, III - score of three and IV score of four to six in which 82%, 53.7%,23.3% and 0% achieved a good outcome respectively (P < 0.05 for all groups). Conclusions The present study identified six independent admission criteria predicting the short-term functional outcome of ICH patients. Their sum may serve to predict the short-term functional outcome upon admission of medically-treated patients with spontaneous supratentorial intracerebral hemorrhage.