Predicting Outcome for Intracerebral Hemorrhage Patients: Current Tools and Their Limitations

 

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Abstract

Accurate outcome prognostication is critical to the management of patients with primary or spontaneous intracerebral hemorrhage (ICH). Prognostication may guide the decision to pursue aggressive acute management or to plan proper goals of care for patients who will likely suffer long-term severe disability. In particular, early predictions of poor outcome for ICH patients routinely influence discussions with surrogate decision makers to pursue do-not-resuscitate orders or comfort care, practices that may often be appropriate, but that are at risk for self-fulfilling prophecies. The authors review the literature pertaining to these concepts. Currently available baseline severity scores, with a focus on the ICH Score, are summarized and compared, with a discussion of the limitations and biases of such clinical scales derived from observational cohorts. New research on the accuracy of the subjective early clinical judgment of physicians and nurses for predicting ICH functional outcome as it compares to that of baseline severity scores, is also summarized.

• References

• 1 Go AS, Mozaffarian D, Roger VL , et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation 2014; 129 (3) e28-e292
  CrossrefPubMedGoogle Scholar
• 2 Zahuranec DB, Lisabeth LD, Sánchez BN , et al. Intracerebral hemorrhage mortality is not changing despite declining incidence. Neurology 2014; 82 (24) 2180-2186
  CrossrefPubMedGoogle Scholar
• 3 van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010; 9 (2) 167-176
  CrossrefPubMedGoogle Scholar
• 4 Hemphill III JC, White DB. Clinical nihilism in neuroemergencies. Emerg Med Clin North Am 2009; 27 (1) 27-37 , vii–viii vii–viii.
  CrossrefPubMedGoogle Scholar
• 5 Diringer MN, Edwards DF, Aiyagari V, Hollingsworth H. Factors associated with withdrawal of mechanical ventilation in a neurology/neurosurgery intensive care unit. Crit Care Med 2001; 29 (9) 1792-1797
  CrossrefPubMedGoogle Scholar
• 6 Zurasky JA, Aiyagari V, Zazulia AR, Shackelford A, Diringer MN. Early mortality following spontaneous intracerebral hemorrhage. Neurology 2005; 64 (4) 725-727
  CrossrefPubMedGoogle Scholar
• 7 Naidech AM, Bernstein RA, Bassin SL , et al. How patients die after intracerebral hemorrhage. Neurocrit Care 2009; 11 (1) 45-49
  CrossrefPubMedGoogle Scholar
• 8 Hemphill III JC, Greenberg SM, Anderson CS , et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46 (7) 2032-2060
  CrossrefPubMedGoogle Scholar
• 9 Hwang BY, Appelboom G, Kellner CP , et al. Clinical grading scales in intracerebral hemorrhage. Neurocrit Care 2010; 13 (1) 141-151
  CrossrefPubMedGoogle Scholar
• 10 Becker KJ, Baxter AB, Cohen WA , et al. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology 2001; 56 (6) 766-772
  CrossrefPubMedGoogle Scholar
• 11 Hemphill III JC, Newman J, Zhao S, Johnston SC. Hospital usage of early do-not-resuscitate orders and outcome after intracerebral hemorrhage. Stroke 2004; 35 (5) 1130-1134
  CrossrefPubMedGoogle Scholar
• 12 Zahuranec DB, Brown DL, Lisabeth LD , et al. Early care limitations independently predict mortality after intracerebral hemorrhage. Neurology 2007; 68 (20) 1651-1657
  CrossrefPubMedGoogle Scholar
• 13 Silvennoinen K, Meretoja A, Strbian D, Putaala J, Kaste M, Tatlisumak T. Do-not-resuscitate (DNR) orders in patients with intracerebral hemorrhage. Int J Stroke 2014; 9 (1) 53-58
  PubMedGoogle Scholar
• 14 Creutzfeldt CJ, Becker KJ, Weinstein JR , et al. Do-not-attempt-resuscitation orders and prognostic models for intraparenchymal hemorrhage. Crit Care Med 2011; 39 (1) 158-162
  CrossrefPubMedGoogle Scholar
• 15 Crandall KM, Rost NS, Sheth KN. Prognosis in intracerebral hemorrhage. Rev Neurol Dis 2011; 8 (1–2) 23-29
  PubMedGoogle Scholar
• 16 Hemphill III JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001; 32 (4) 891-897
  CrossrefPubMedGoogle Scholar
• 17 Fernandes H, Gregson BA, Siddique MS, Mendelow AD. Testing the ICH score. Stroke 2002; 33 (6) 1455-1456 , author reply 1455–1456
  CrossrefPubMedGoogle Scholar
• 18 Jamora RD, Kishi-Generao Jr EM, Bitanga ES, Gan RN, Apaga NE, San Jose MC. The ICH score: predicting mortality and functional outcome in an Asian population. Stroke 2003; 34 (1) 6-7 , author reply 6–7
  CrossrefPubMedGoogle Scholar
• 19 Godoy DA, Boccio A. ICH score in a rural village in the Republic of Argentina. Stroke 2003; 34 (9) e150-e151 , author reply e150–e151
  CrossrefPubMedGoogle Scholar
• 20 Cheung RT, Zou LY. Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage. Stroke 2003; 34 (7) 1717-1722
  CrossrefPubMedGoogle Scholar
• 21 Clarke JL, Johnston SC, Farrant M, Bernstein R, Tong D, Hemphill III JC. External validation of the ICH score. Neurocrit Care 2004; 1 (1) 53-60
  CrossrefPubMedGoogle Scholar
• 22 Matchett SC, Castaldo J, Wasser TE, Baker K, Mathiesen C, Rodgers J. Predicting mortality after intracerebral hemorrhage: comparison of scoring systems and influence of withdrawal of care. J Stroke Cerebrovasc Dis 2006; 15 (4) 144-150
  CrossrefPubMedGoogle Scholar
• 23 Patriota GC, Silva-Júnior JM, Barcellos AC , et al. Determining ICH Score: can we go beyond?. Arq Neuropsiquiatr 2009; 67 (3A): 605-608
  CrossrefPubMedGoogle Scholar
• 24 Sia SF, Tan KS, Waran V. Primary intracerebral haemorrhage in Malaysia: in-hospital mortality and outcome in patients from a hospital based registry. Med J Malaysia 2007; 62 (4) 308-312
  PubMedGoogle Scholar
• 25 Hemphill III JC, Farrant M, Neill Jr TA. Prospective validation of the ICH Score for 12-month functional outcome. Neurology 2009; 73 (14) 1088-1094
  CrossrefPubMedGoogle Scholar
• 26 van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19 (5) 604-607
  CrossrefPubMedGoogle Scholar
• 27 Appelboom G, Bruce SS, Han J , et al. Functional outcome prediction following intracerebral hemorrhage. J Clin Neurosci 2012; 19 (6) 795-798
  CrossrefPubMedGoogle Scholar
• 28 Ruiz-Sandoval JL, Chiquete E, Romero-Vargas S, Padilla-Martínez JJ, González-Cornejo S. Grading scale for prediction of outcome in primary intracerebral hemorrhages. Stroke 2007; 38 (5) 1641-1644
  CrossrefPubMedGoogle Scholar
• 29 Godoy DA, Piñero G, Di Napoli M. Predicting mortality in spontaneous intracerebral hemorrhage: can modification to original score improve the prediction?. Stroke 2006; 37 (4) 1038-1044
  CrossrefPubMedGoogle Scholar
• 30 Chuang YC, Chen YM, Peng SK, Peng SY. Risk stratification for predicting 30-day mortality of intracerebral hemorrhage. Int J Qual Health Care 2009; 21 (6) 441-447
  CrossrefPubMedGoogle Scholar
• 31 Weimar C, Ziegler A, Sacco RL, Diener HC, König IR ; VISTA investigators. Predicting recovery after intracerebral hemorrhage—an external validation in patients from controlled clinical trials. J Neurol 2009; 256 (3) 464-469
  CrossrefPubMedGoogle Scholar
• 32 Rost NS, Smith EE, Chang Y , et al. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke 2008; 39 (8) 2304-2309
  CrossrefPubMedGoogle Scholar
• 33 Tape TG. Introduction to ROC curves. Available at: http://gim.unmc.edu/dxtests/roc1.htm . Accessed November 12, 2015
  PubMedGoogle Scholar
• 34 Bruce SS, Appelboom G, Piazza M , et al. A comparative evaluation of existing grading scales in intracerebral hemorrhage. Neurocrit Care 2011; 15 (3) 498-505
  CrossrefPubMedGoogle Scholar
• 35 Morgenstern LB, Zahuranec DB, Sánchez BN , et al. Full medical support for intracerebral hemorrhage. Neurology 2015; 84 (17) 1739-1744
  CrossrefPubMedGoogle Scholar
• 36 Hwang DY, Dell CA, Sparks MJ , et al. Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes. Neurology 2016; 86 (2) 126-133
  CrossrefPubMedGoogle Scholar
• 37 Creutzfeldt CJ, Holloway RG. Treatment decisions after severe stroke: uncertainty and biases. Stroke 2012; 43 (12) 3405-3408
  CrossrefPubMedGoogle Scholar
• 38 Boyd EA, Lo B, Evans LR , et al. “It's not just what the doctor tells me:” factors that influence surrogate decision-makers' perceptions of prognosis. Crit Care Med 2010; 38 (5) 1270-1275
  CrossrefPubMedGoogle Scholar
• 39 Holloway RG, Gramling R, Kelly AG. Estimating and communicating prognosis in advanced neurologic disease. Neurology 2013; 80 (8) 764-772
  CrossrefPubMedGoogle Scholar
• 40 Cho DY, Chen CC, Lee WY, Lee HC, Ho LH. A new Modified Intracerebral Hemorrhage score for treatment decisions in basal ganglia hemorrhage—a randomized trial. Crit Care Med 2008; 36 (7) 2151-2156
  CrossrefPubMedGoogle Scholar