24-Hour ICH Score Better Prognostic Indicator Than ICH Score at Admission

New Orleans, LA — Although the intra-cerebral hemorrhage (ICH) score at hospital admission is typically used to estimate the potential prognosis in stroke patients, a new study suggests that the 24-hour ICH score is a more accurate assessment. According to 24-hour ICH scores, a proportion of patients with low ICH admission scores may worsen substantially.

“Studies have shown that ICH volume is dynamic, and that more than a third of patients experience volume growth within the first 24 hours. Based on our study, we think that prognostication of risk for major disability and death should be deferred until 24 hours after arrival of patients with ICH,” explained lead author Aimee Aysenne, MD, neurology resident at Tulane University School of Medicine, New Orleans, LA.

The study was based on a retrospective chart review of 89 consecutive patients with spontaneous ICH admitted to Tulane Hospital from July 1, 2008, through December 30, 2010. All patients were given an ICH score based on age, the Glasgow Coma Scale Score, intraventricular extension, and ICH location and volume at admission.

The mean age of the patients in the study was 58 years. Of the patients, 51% were male and 75% were black. About 50% were receiving antihypertensive therapy and 36% were on antithrombotic agents at the baseline of the study. About 46% of infarcts were located in the basal ganglia, 20% in the thalamus, 20% in the lobar region of the brain, 5% in the pons, and 5% in the cerebellum.

Of 121 screened patients, 89 showed both admission ICH scores and 24-hour ICH scores. No patient with a baseline ICH score of 4 or 5 had a 24-hour ICH score available. In 38% of the patients, a change in the ICH score occurred over 24 hours. The ICH score improved in 14 patients and worsened in 20 patients.

Results suggested that early determination of ICH score might underestimate the severity of stroke, especially in patients with an admission ICH score of 1. By 24 hours, ICH score worsened in 36% of this group. With early aggressive intervention, many patients with an admission ICH score of 3 improved to a lower score at 24 hours.