A grading scale for surgically treated patients with spontaneous supratentorial intracerebral hemorrhage: the Surgical Swedish ICH Score

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OBJECTIVE

The authors aimed to develop the first clinical grading scale for patients with surgically treated spontaneous supratentorial intracerebral hemorrhage (ICH).

METHODS

A nationwide multicenter study including 401 ICH patients surgically treated by craniotomy and evacuation of a spontaneous supratentorial ICH was conducted between January 1, 2011, and December 31, 2015. All neurosurgical centers in Sweden were included. All medical records and neuroimaging studies were retrospectively reviewed. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the Surgical Swedish ICH [SwICH] Score) was developed using weighting of independent predictors based on strength of association.

RESULTS

Factors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score (p = 0.00015), ICH volume ≥ 50 mL (p = 0.031), patient age ≥ 75 years (p = 0.0056), prior myocardial infarction (MI) (p = 0.00081), and type 2 diabetes (p = 0.0093). The Surgical SwICH Score was the sum of individual points assigned as follows: GCS score 15–13 (0 points), 12–5 (1 point), 4–3 (2 points); age ≥ 75 years (1 point); ICH volume ≥ 50 mL (1 point); type 2 diabetes (1 point); prior MI (1 point). Each increase in the Surgical SwICH Score was associated with a progressively increased 30-day mortality (p = 0.0002). No patient with a Surgical SwICH Score of 0 died, whereas the 30-day mortality rates for patients with Surgical SwICH Scores of 1, 2, 3, and 4 were 5%, 12%, 31%, and 58%, respectively.

CONCLUSIONS

The Surgical SwICH Score is a predictor of 30-day mortality in patients treated surgically for spontaneous supratentorial ICH. External validation is needed to assess the predictive value as well as the generalizability of the Surgical SwICH Score.

ABBREVIATIONS AIC = Akaike information criterion; GCS = Glasgow Coma Scale; ICH = intracerebral hemorrhage; IVH = intraventricular hemorrhage; MI = myocardial infarction; NOAC = non–vitamin K antagonist oral anticoagulant; Surgical SwICH Score = Surgical Swedish ICH Score; VKA = vitamin K antagonist.

Article Information

Correspondence Niklas Marklund: Lund University, Skane University Hospital, Lund, Sweden. niklas.marklund@med.lu.se.

INCLUDE WHEN CITING Published online August 23, 2019; DOI: 10.3171/2019.5.JNS19622.

Disclosures This work has been supported by ALF funds from Uppsala University Hospital and Region Östergötland. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Kaplan-Meier survival curve showing 30-day mortality. The overall 30-day mortality was 14%.

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    Confirmed 30-day mortality in comparison to the predicted 30-day mortality according to the ICH Score. The ICH Score was calculated as the sum of individual points assigned as follows: GCS score 3 or 4 (2 points), 5–12 (1 point), 13–15 (0 points); age ≥ 80 years, yes (1 point), no (0 points); infratentorial origin, yes (1 point), no (0 points); ICH volume ≥ 30 mL (1 point), < 30 mL (0 points); and IVH, yes (1 point), no (0 points). The confirmed 30-day mortality in the cohort was 14%, in contrast to the mortality predicted by the ICH Score, which was 52%. The range of ICH Scores in this patient group was between 1 and 4 points, and 30-day mortality increased as the ICH Scores increased. Nevertheless, there was a significant difference between the predicted and confirmed 30-day mortality overall and in each point group (p < 0.001).

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    A: Independent predictors of 30-day mortality. B: 30-day mortality as a function of age. C: 30-day mortality as a function of ICH volume. T2D = type 2 diabetes.

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    Thirty-day mortality in relation to calculated Surgical SwICH Score. The range of Surgical SwICH Scores in the cohort was 0–4. No patient with a Surgical SwICH Score of 0 died. Each increase in the Surgical SwICH Score was associated with a progressive increase in 30-day mortality (p for trend 0.0002).

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