Computed tomography patterns, score and outcome of Intracerebral Hemorrhage among patients attending Muhimbili Orthopedic Institute and Muhimbili National Hospital-Mloganzila

Abstract

ABSTRACT Background: Intracerebral hemorrhage (ICH) is life threatening form of stroke and is characterized bleeding into the brain parenchyma, it is associated with high mortality rates, and poor recovery outcomes. The mortality rate is nearly 50% within the first month and only 20% of the patient survived can live independently. There is significant increase in number of patients with ICH due to rise in number of non-communicable diseases. With all this early outcome assessment is important in order to optimize the treatment options of these patients. Objective: The main purpose of this study was to investigate the computed tomography patterns ICH score and 30days outcome of intracerebral hem orrhage among patients attending Muhimbili orthopedic institute and Muhimbili national hospital. Methodology: This was a hospital-based prospective cross-sectional conducted at Muhimbili National Hospital (MNH)-Mloganzila and Muhimbili Orthopedic Institute (MOI) from September 2023 to March 2024. We analyzed data from 142 patients with ICH to evaluate CT patterns, severity score (ICH score) and possible predictors of 30day mortality by considering clinical, radiological and treatment parameters. Data from this study was analyzed using Statistical Package for Social Sciences (SPSS) version 23. Data was compared using cross tabulation and chi square statistical test was used to check for the association between the independent variables and 30- day mortality outcome (p value <0.05). Univariate and multivariate logistic regression was used to check for the magnitude and direction of the association for the variable shown to be statically significant. Kaplan Meier survival curve was done for two ICH categories to check for their association with 30days mortality rate. Results: A total of 142 patients with ICH were studied. The mean age of the patients was (55±11) years, with a predominance of males (60%). Nearly all patients had hypertension (96%), a notable proportion had diabetes mellitus (14%) and 4% were smokers. Most ICHs were supratentorial (93%), primarily located in the basal ganglia (52%). A majority of patients (63%) had hematoma volumes >30cm³, and 66% exhibited hydrocephalus. Mortality rate in this study was 46%. Higher mortality rates were associated with larger hematoma volumes ≥30cc (p value<0.001), midline shift (p value<0.001), hydrocephalus (p value<0.001), higher ICH scores (≥3) (p value<0.001), presence of underlying lesion (p value<0.001) older age (>55 years) ( p value<0.01), male gender (p value <0.03) and the presence of underlying lesions (aneurysms). The mortality rate in patients with ICH score of 4 was 100%. Patients with higher ICH scores (≥3) had poor 30-day survival probability (0.25) (P<0.0001). Conclusion.Majority (96%) of patients with spontaneous ICH are hypertensive and male are more affected as compared to female. Most of ICH are supratentorial in location. ICH is associated with high 30-days mortality (46%), it is almost 100% in patients with ICH score of 4. ICH score at admission, larger hematoma volumes, midline shift hydrocephalus, older age, male gender and the presence aneurysms are strong predictors of 30‑day mortality in patients with spontaneous ICH. Recommendation: ICH score should be used for risk stratification to aid in patient management decision-making. There is a need for more studies with a bigger sample size to elicit the causes of death of patients on the EVD placement and also explore causes of high mortality (100%) in patients with an ICH score of 4 in our settings.