A Study On Hospital Admission,surgical Treatment And Outcome In Patients With Intracerebral Hemorrhage

BackgroundIntracerebral hemorrhage(ICH)is one of the fatal type of stroke with high mortality and disability rates.The incidence of stroke increases on weekends and at off-hours period.Whether the admission time to the hospital,outside or during the regular working hours,influences the functional outcome or mortality in ICH is debatable.Therefore,we studied the effect of off hour admission on functional outcomes of ICH patients.MethodsWe retrospectively analyzed a prospective cohort of ICH patients,admitted between January 2017 and December 2019.Acute ICH patients within 72 hour after onset,with baseline CT,and 3-month follow up were included in our study.Patients admitted to the hospital from 6 pm to 8 am,Monday to Sunday were considered as off hour admission Three-month functional outcomes were assessed using modified Rankin Scale(m RS)score.The m RS score >3 was regarded as poor outcome.Multivariable logistic regression analysis was performed for calculating odd ratios(OR)and 95% confidence interval(CI)for functional outcome measurements.ResultsOf the 656 participants,318(48.5%)were admitted during on hours whereas 338(51.5%)were admitted during off hours.Baseline characteristics including history of hypertension,diabetes,ischemic stroke,and use of anti-platelet,anti-hypertensive and statin were similar between on and off hour admissions.Patients with poor outcome had larger median baseline ICH volume(27 ml [IQR 11.1-53.2 ml] vs 8.5 ml [IQR 3.3-16.7ml]),shorter median time from onset to CT(2.8 hours [IQR 1.4-9.6 hours]vs 6.5 hours [2.5-22.3 hours]).Off-hour admission was associated with poor functional outcome at 3 months after adjusting for age,intraventricular hemorrhage,admission systolic blood pressure,admission GCS score,time from onset to CT(OR 2.17,95% CI 1.34-3.52;P = 0.002).ConclusionWe found that patients admitted during off-hours had higher risk of poor functional outcomes at 3 months than those admitted during working time.BackgroundThe outcome for the lobar intracerebral hemorrhage(ICH)based upon their treatment technique including surgical or conservative medical management has not been compared.In order to compile and review the evidence regarding the management for patients with lobar ICH,we performed the current meta-analysis.MethodsWe searched the online electronic databases including Pub Med,Google scholar,Medline,Embase and Cochrane Library for randomized controlled trials.Studies with CT-confirmed lobar ICH patients treated within 72 hours from stroke onset were included.We excluded the trials of low quality.The primary outcome was the death or dependence,whereas the secondary outcome was death at the end of the follow up.ResultsOut of one hundred and five screened trials,ninety six studies were excluded.Nine studies which met the eligibility criteria were assessed for the quality and seven studies comprising 1102 patients were included in the meta-analysis.The Odds ratio(OR)for the primary outcome was 0.80(95%CI,0.62–1.04,P = 0.09)and for the secondary outcome was 0.79(95%CI,0.60–1.03,P = 0.09).ConclusionWe found that there is no statistically significant difference in the surgical versus conservative medical management for lobar ICH.BackgroundIntracerebral hemorrhage(ICH)with intraventricular hemorrhage(IVH)is significant clinical challenge due to its poor outcomes.IVH worsens the clinical course,leading to increased mortality and poor functional outcomes.Surgical ventricular drainage(VD)is therapeutic technique to alleviate complications associated with IVH.This study aims to assess the impact of VD on mortality and neurological outcome in ICH patients with IVH.MethodsWe retrospectively analyzed a prospective cohort of ICH patients,admitted between January 2016 and December 2021.Primary ICH patients admitted within 72 hour following ICH onset,with baseline CT,and 3-month follow up were included in our study.ICH patients were divided into two groups;ICH without IVH and ICH with IVH.ICH patients with IVH were further categorized into IVH with VD and IVH without VD.Three-month functional outcomes were assessed using modified Rankin Scale(m RS)score.The m RS score >3 was regarded as poor outcome.Multivariable logistic regression analysis was performed for calculating odd ratios(OR)and 95% confidence interval(CI)for functional outcome and mortality.ResultsWe initially identified 1918 ICH patients,1820 patients were included in the analysis.Out of the total 1820 patients,1202(66.05%)were without intraventricular hemorrhage(IVH)and 618(33.95%)had intraventricular hemorrhage.ICH patient with IVH were further subdivided into IVH with VD(15.85%)group and IVH without VD group(84.15%).VD was placed in 15% of the patients with IVH and 1.1 % of the patients without IVH.ICH patients with IVH had a significantly larger ICH volume(median 15.63 ml vs.7.44 ml,p < 0.001),higher IVH volume(median 4.97 ml vs.0 ml,p <0.001),lower median admission Glasgow Coma Scale(GCS)score(12.0 vs.15.0,p < 0.001)and higher median admission National Institutes of Health Stroke Scale(NIHSS)score(13.0 vs.5.0,p < 0.001)compared to those without IVH.In univariate analysis VD placement was associated with reduced risk of 90-day mortality(15.6% vs.26.2%,p = 0.028),but with similar functional dependence at 90-day mark(35.1% vs.38.2%,p = 0.574).In multivariate analysis,VD placement was associated with lower odds of mortality(OR 0.261,95% CI: 0.128-0.529,p = <0.001),but not with the odds of functional outcome(OR 0.913,95% CI: 0.492-1.693,p =0.772).ConclusionWe concluded that after controlling the confounding variables,VD is independently associated with lower mortality but it does not appear to be an independent predictor of good neurological outcomes among ICH patients with IVH.Further research is needed to fully comprehend the significance of VD in clinical practice and its impact on patient outcomes.The findings highlight the importance for considering multiple factors in the management of ICH patients with IVH.