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Is using intracerebral hemorrhage scoring systems valid for mortality prediction in surgically treated patients?
Neurosurgical Review ( IF 2.8 ) Pub Date : 2021-01-07 , DOI: 10.1007/s10143-020-01451-8
Sukwoo Hong 1 , Keisuke Maruyama 1 , Akio Noguchi 1 , Teruyuki Hirano 2 , Motoo Nagane 1 , Yoshiaki Shiokawa 1
Affiliation  

While intracerebral hemorrhage (ICH) scoring systems provide mortality and morbidity prediction, the actual mortality rates seem to be lower than those predicted by scoring systems in our clinical impression. To assess the validity of the ICH score and the Surgical Swedish ICH (SwICH) score, we retrospectively reviewed surgically treated ICH patients between 2012 and 2019. Uni- and multivariate analyses were performed to identify variables in predicting 30-day mortality. We identified 203 patients (mean ICH score 2.7; mean SwICH score 2.0). The actual 30-day mortality was 7%, which was significantly lower than those predicted by the ICH and the SwICH scores (55% and 16%, respectively; p < 0.001). Both scores were strongly correlated with the modified Rankin scale (mRS) at discharge (correlation coefficient 0.97 and 0.98; critical value 0.81). The only significant prognostic factors for the 30-day mortality by multivariate analysis were anisocoria (p = 0.03) and preoperative Glasgow Coma Scale (p = 0.03). These two factors also predicted mRS at discharge (p < 0.001). After discharge, 15% of patients improved regarding mRS and 29% of wheelchair-bound patients gained the ability to ambulate. No significant relationship existed between the degree of recovery after discharge and preoperative ICH score (p = 0.25). The ICH and SwICH scores were more valid in predicting morbidity, rather than mortality after surgical intervention for ICH. Anisocoria and Glasgow Coma Scale < 7 were the only two factors that predicted 30-day mortality and morbidity at discharge.



中文翻译:

使用脑出血评分系统对接受手术治疗的患者的死亡率预测是否有效?

虽然脑出血 (ICH) 评分系统提供死亡率和发病率预测,但实际死亡率似乎低于我们临床印象中评分系统预测的死亡率。为了评估 ICH 评分和瑞典外科 ICH (SwICH) 评分的有效性,我们回顾性审查了 2012 年至 2019 年间接受手术治疗的 ICH 患者。进行了单变量和多变量分析以确定预测 30 天死亡率的变量。我们确定了 203 名患者(平均 ICH 评分 2.7;平均 SwICH 评分 2.0)。实际 30 天死亡率为 7%,显着低于 ICH 和 SwICH 评分的预测值(分别为 55% 和 16%;p < 0.001)。两个分数都与出院时的改良兰金量表 (mRS) 密切相关(相关系数为 0.97 和 0.98;临界值为 0.81)。通过多变量分析,30 天死亡率的唯一重要预后因素是异位症 ( p  = 0.03) 和术前格拉斯哥昏迷量表 ( p  = 0.03)。这两个因素也预测出院时的 mRS ( p  < 0.001)。出院后,15% 的患者在 mRS 方面有所改善,29% 的轮椅患者获得了行走能力。出院后恢复程度与术前ICH评分无显着相关性(p = 0.25)。ICH 和 SwICH 评分在预测 ICH 手术干预后的发病率而非死亡率方面更有效。Anisocoria 和 Glasgow Coma Scale < 7 是仅有的两个预测出院时 30 天死亡率和发病率的因素。

更新日期:2021-01-07
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