Stroke: large haemorrhage size, ventricular extension and low initial Glasgow Coma Scale score increased the risk of mortality.

Clinical bottom line (level 2b)

  1. A quarter of black Americans with spontaneous intracerebral haemorrhage deteriorated within 24 hours.
  2. Black Americans with spontaneous intracerebral haemorrhage were at an increased risk of early deterioration if they had ventricular extension or haemorrhage volume > or = 30 cm ³ .
  3. Half of black Americans with spontaneous intracerebral haemorrhage died in hospital.
  4. Black Americans with spontaneous intracerebral haemorrhage were at an increased risk of in-hospital mortality if they had a haemorrhage volume of > or = 30 cm ³ , had ventricular extension or had an initial Glasgow Coma Scale score of <12
Qureshi et al: Stroke 1995; 26: 1764-1767
Expires December 2002

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: general hospital, USA

182 patients (aged mean 58 years, 58% male) spontaneous intracerebral haemorrhage confirmed by CT scan

Excluded if
  • intracerebral haemorrhage suspected or known to be secondary to infection
  • brain tumour
  • vasculitis
  • trauma
  • arteriovenous malformation
  • rupture of berry aneurysm
  • haemorrhagic transformation of prior cerebral infarction



    • Factors studied:
  • early deterioration and mortality
  • ventricular extension
  • intracerebral haemorrhage volume > or = 30 cm ³
  • intracerebral haemorrhage volume > or = 30 cm ³
  • ventricular extension
  • initial Glasgow Coma Scale score < or = 12




    • Multiple logistic regression was used to adjust for confounding factors.

    100% followed for hospital stay
    Outcomes studied:
  • early deterioration initial Glasgow Coma Scale score >12, then decreasing by = 4 points within 24 hours from presentation
  • mortality

    • Patients were 100% black Americans

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    early deterioration hospital stay 22/95 23.2%
    (14.7% to 31.6%)
    mortality hospital stay 92/182 50.6%
    (43.3% to 57.8%)

    prognostic factor for
    early deterioration     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    ventricular extension 24 hours 7/65
    (10.8%)     		4.67
    (1.30 to 16.7)     		4
    (2 to 36)
    intracerebral haemorrhage volume > or = 30 cm ³ 24 hours 7/70
    (10.0%)     		6.78
    (1.89 to 24.4)     		3
    (2 to 14)

    prognostic factor for
    mortality     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    intracerebral haemorrhage volume > or = 30 cm ³ ? 22/98
    (22.5%)     		6.66
    (2.85 to 15.6)     		2
    (2 to 4)
    ventricular extension ? 26/99
    (26.3%)     		4.23
    (1.82 to 9.82)     		3
    (2 to 8)
    initial Glasgow Coma Scale score < or = 12 ? 29/95
    (30.5%)     		3.23
    (1.46 to 7.14)     		4
    (2 to 12)

    Citation

    1. Qureshi AI, Safdar K, Weil EJ, et al: Predictors of early deterioration and mortality in black Americans with spontaneous intracerebral hemorrhage. Stroke 1995; 26: 1764-1767
    Contributor: Clare Wotton and Bob Phillips, December 1999
    Reviewer:

    Clinical Question.
    Patient black Americans with spontaneous intracerebral haemorrhage
    Intervention or Exposure presence of prognostic factors
    Comparison absence of prognostic factors
    Outcome mortality and early deterioration