A simple CT score predicts early neurological disability and survival in supratentorial intracerebral hemorrhage - The intracerebral mass and brain edema score (IMBES)

Abstract

Introduction

Treatment of spontaneous intracerebral hemorrhage (ICH) remains challenging, and intracerebral mass and brain edema (IMBE) are accused of being the main factors influencing patient course.

Research question

CT scan assessment of the space-occupying effect after initial ICH was evaluated using an IMBE-score to detect the sulcal effacement of the subarachnoid space.

Material and methods

Supratentorial ICH-patients within a 10 years observation period were identified. Two independent reviewers screened each CT scan in three defined axial planes. Where the combined mass effect of hemorrhage and edema showed sulcal effacement of more than half of the hemisphere, one point was assigned, resulting in an IMBES between 0 and 6. The primary endpoint was neurological outcome measured by the modified Rankin Scale (mRS) and mortality.

Results

We identified 762 patients, median age was 75.4 years (IQR: 64.3–81.1) and mean ICH volume was 46.1 cc. Multiple regression for mRS at discharge (mean: 12.5 days, IQR: 7.1–22.3) identified age, presence of intraventricular hemorrhage, ICH volume, renal insufficiency, intake of anticoagulants and IMBES as statistically significant variables. This was confirmed during follow-up examination, although ICH volume was not significantly associated with neurological outcome.

Discussion and conclusion

We observed a decreased neurological recovery and an increased mortality for patients with high IMBES during acute care and at early follow-up, indicating that IMBES had the strongest association in all regression analysis. We conclude that the fast and simple IMBES may be a useful tool to estimate patient risk for impaired neurological outcome and death.