Article
Appraisal of ICH- and ICH-GS score in surgically and conservatively treated cerebellar haemorrhage after 20 years
Die Bedeutung von ICH- und ICH-GS score bei chirurgisch und konservativ behandelter Kleinhirnblutung nach 20 Jahren
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Published: | May 25, 2022 |
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Objective: Outcome prognostication represents a crucial step during acute care of intracerebral hemorrhage (ICH). Cerebellar hemorrhage represents the minority of ICH, requiring special considerations in this posterior fossa pathology. The aim of this study was to validate ICH- and ICH-GS score in patients with cerebellar hemorrhage and compare the functional outcome in patients with surgical or conservative treatment.
Methods: This was a multicenter study for validation of ICH- and ICH-GS scores in patients with cerebellar hemorrhage. Patients presenting to 9 different neurosurgical departments in Germany between 2005 and 2021 were enrolled in this study. After validation of both scoring systems, we stratified the cohort by surgical and conservative arms and compared the mortality and functional outcome at discharge and 6 months follow-up.
Results: Among 475 patients with cerebellar hemorrhage, 403 patients (85%) were eligible for analysis. Of those, 252 patients (62.5%) underwent surgical and 151 patients (37.5%) conservative treatment. Both ICH- and ICH-GS score showed good prognostic accuracy for both mortality rate and functional outcome (all AUC >0.7 with asymptotic p-value <0.001). The mortality rate was significantly lower in the surgical arm in patients with ICH score greater than 3 (p=0.001) and ICH-GS score greater than 11 (p<0.001). However, mortality rate was significant higher in patients treated surgically with an ICH score of <3 (p=0.001). The conservative arm displayed a significantly higher favorable outcome in patients with an ICH score 3 (p<0.001) whereas there was a trend towards better outcome in the surgical arm with ICH- and ICH-GS score greater than 3 and 10, respectively.
Conclusion: In patients with cerebellar hemorrhage, conservative treatment may be adequate in patients with lower ICH- and ICH-GS score, while surgical treatment may promote better outcome in patients presenting with high ICH- and ICH-GS scores.