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Full medical support for intracerebral hemorrhage
Journal article   Open access   Peer reviewed

Full medical support for intracerebral hemorrhage

Lewis B Morgenstern, Darin B Zahuranec, Brisa N Sánchez, Kyra J Becker, Madeleine Geraghty, Rebecca Hughes, Gregory Norris and J Claude Hemphill, 3rd
Neurology, v 84(17), pp 1739-1744
28 Apr 2015
DOI: https://doi.org/10.1212/WNL.0000000000001525
PMID: 25817842
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1212/wnl.0000000000001525View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open
url
https://doi.org/10.1212/WNL.0000000000001525View
Published, Version of Record (VoR) Open

Abstract

Adult Aged Aged, 80 and over Cerebral Hemorrhage - mortality Cerebral Hemorrhage - pathology Cerebral Hemorrhage - therapy Disability Evaluation Female Glasgow Coma Scale Humans Male Middle Aged Practice Guidelines as Topic Prospective Studies Resuscitation Orders Time Factors Treatment Outcome United States - epidemiology
This study tested the hypothesis that patients without placement of new do-not-resuscitate (DNR) orders during the first 5 days after intracerebral hemorrhage (ICH) have lower 30-day mortality than predicted by the ICH Score without an increase in severe disability at 90 days. This was a prospective, multicenter, observational cohort study at 4 academic medical centers and one community hospital. Adults (18 years or older) with nontraumatic spontaneous ICH, Glasgow Coma Scale score of 12 or less, who did not have preexisting DNR orders were included. One hundred nine subjects were enrolled. Mean age was 62 years; median Glasgow Coma Scale score was 7, and mean hematoma volume was 39 cm(3). Based on ICH Score prediction, the expected overall 30-day mortality rate was 50%. Observed mortality was substantially lower at 20.2%, absolute average difference 29.8% (95% confidence interval: 21.5%-37.7%). At 90 days, 27.1% had died, 21.5% had a modified Rankin Scale score = 5 (severe disability). A good outcome (modified Rankin Scale score 0-3) was achieved by 29.9% and an additional 21.5% fell into the moderately severe disability range (modified Rankin Scale score = 4). Avoidance of early DNR orders along with guideline concordant ICH care results in substantially lower mortality than predicted. The observed functional outcomes in this study provide clinicians and families with data to determine the appropriate goals of treatment based on patients' wishes.

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98 citations in Web of Science
109 citations in Scopus

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Clinical Neurology
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