24-Hour ICH Score Is a Better Predictor of Outcome than Admission ICH Score

Background. The ICH score is a validated tool for predicting 30-day morbidity and mortality in patients with intracerebral hemorrhage. Aims and/or Hypothesis. The aim of this study is to determine if the ICH score calculated 24 hours after admission is a better predictor of mortality than the ICH score calculated on admission. Methods. Patients presenting to our center with ICH from 7/08–12/10 were retrospectively identified from our prospective stroke registry. ICH scores were calculated based on initial Glasgow coma scale (GCS) and emergent head computed tomography (CT) on initial presentation and were recalculated after 24 hours. Results. A total of 91 patients out of 121 had complete data for admission and 24-hour ICH score. The ICH score changed in 38% from baseline to 24 hours. After adjusting for age, NIHSS on admission, and glucose, ICH score at 24 hours was a significant, independent predictor of mortality (OR = 2.71, 95% CI 1–19–6.20, and ), but ICH score on admission was not (OR = 2.14, 95% CI 0.88–5.24, and ). Conclusion. Early determination of the ICH score may incorrectly estimate the severity and expected outcome after ICH. Calculations of the ICH score 24 hours after admission will better predict early outcomes. 1. Introduction The intracerebral hemorrhage (ICH) score was developed as a predictive tool for mortality at thirty days after hemorrhagic stroke [1]. The ICH score is a 6-point calculation based on five clinical indicators: age > 80 years, Glasgow coma scale (GCS), volume of hematoma on baseline CT scan, location (infratentorial or supratentorial), and the presence of intraventricular extension. The ICH score has also been validated for 30-day and one-year functional outcome in additional studies [2, 3]. In these studies the GCS was measured at the time of admission to the intensive care unit (ICU) or to the operating room regardless of the time of onset of symptoms. Almost 40% of patients with brain imaging obtained in the first 3 hours after onset of symptoms of ICH experience hematoma expansion and this is highly associated with neurological deterioration [4]. Recent studies show a strong association between contrast extravasation on computed tomography angiography (CTA) and hematoma expansion and worse outcome [5]. 2. Aims and/or Hypothesis We hypothesize that, due to the dynamic nature of early ICH, with high risk of hematoma expansion, new IVH, and decreasing level of consciousness, a delayed measure of the ICH score would be more useful in predicting outcomes. In our center, the ICH score is calculated once all five