Early mortality in spontaneous supratentorial intracerebral haemorrhage

• Published in: Neurocirugía (Asturias, Spain) Vol. 21; no. 2; pp. 93 - 98
• Main Authors: Samprón, N, Urculo, E, Mendia, A, Azkarate, B, Alberdi, F, Arrazola, M
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España 01-04-2010; Sociedad Española de Neurocirugía
• Subjects: Aged; Cerebral Hemorrhage - mortality; Cerebral Hemorrhage - pathology; Cerebral Hemorrhage - surgery; Craneotomía; Craniotomy; Early mortality; Escala de coma de Glasgow; Female; Glasgow Coma Scale; Glasgow Coma Score; Hematoma - pathology; Hematoma - surgery; Hemorragia intracerebral; Hipertensión arterial; Humans; Hypertension; ICU management; Intensive Care Units; Intracerebral haemorrhage; Male; Mortalidad temprana; Neurosurgery; Prospective Studies; Treatment Outcome; Unidad de Cuidados Intensivos; Hypertension; Hemorragia intracerebral; Intracerebral haemorrhage; Early mortality; Hipertensión arterial; digital subtraction angiography; Glasgow coma score. Escala de coma de Glasgow; Escala de coma de Glasgow; ICH; Glasgow Coma Score; DSA; Craneotomía; STICH; GCS; surgical trial in intracerebral haemorrhage; Craniotomy; ICU management; ICU; intensive care unit; UCI; Unidad de Cuidados Intensivos; Mortalidad temprana
• ISSN: 1130-1473
• DOI: 10.1016/S1130-1473(10)70063-4

Summary Background Spontaneous supratentorial intracerebral haemorrhage is a severe, frequent, and poorly understood condition. Despite the publication of 12 randomised controlled trials on this subject, the role of surgery remains controversial and no treatment has proved to be effective. We report on a ten year prospective cohort study based on a defined population treated with or without surgery and their outcome in terms of early survival. Methods Population based, ten year prospective observational study directed to patients consecutively admitted to the Intensive Care Unit (ICU) in a tertiary centre with spontaneous supratentorial intracerebral haemorrhage. Patients were distributed in five groups according to the Glasgow Coma Score (GCS) at admission. Haemorrhages were classified as deep-seated or superficial. All patient received standard medical care, and additionally surgery if it was found indicated by the duty neurosurgeon. Primary endpoint was early mortality defined as dead occurred by any cause during the admission in the ICU. Findings During the ten year period, 1.485 patients were admitted to our centre with primary intracerebral haemorrhage. Of these, 376 were admitted to the intensive care unit and 285 sustained supratentorial haemorrhages. Low GCS was strong predictor of early mortality. Despite the larger size of haematomas in patients undergoing surgical evacuation, surgery was associated with lower early mortality in all GCS sub-groups. Maximal benefit was observed in patient with admission GCS of 4–8. Superficial haematomas were operated on more often, and were associated with lower mortality rate than deep-seated cases. Conclusions Our findings suggest that craniotomy for haematoma evacuation may reduce early mortality in patients with primary supratentorial intracerebral haemorrhage. Surgery seems specially useful in patients with admission GCS between 4 and 8, and in those with superficial haemorrhages.