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Clinical Course and Outcomes of Small Supratentorial Intracerebral Hematomas.

Behrouz, R, Misra, V, Godoy, DA, Topel, CH, Masotti, L, Klijn, CJM, Smith, CJ, Parry-Jones, AR, Slevin, MA, Silver, B, Willey, JZ, Masjuán Vallejo, J, Nzwalo, H, Popa-Wagner, A, Malek, AR, Hafeez, S and Di Napoli, M (2017) Clinical Course and Outcomes of Small Supratentorial Intracerebral Hematomas. Journal of Stroke & Cerebrovascular Diseases : the official journal of National Stroke Association, 26 (6). pp. 1216-1221. ISSN 1052-3057

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Abstract

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.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.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).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.

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