Functional outcome after surgical treatment for spontaneous intracerebral hemorrhages: Development of the HeMAtOma score

Background

Spontaneous intracerebral hemorrhage (sICH) is a critical medical emergency associated with significant morbidity and mortality. The role of surgical intervention in improving functional outcomes remains a subject of debate.

Objective

This study evaluates the functional outcomes of patients undergoing surgical treatment for sICH and identifies risk factors predictive of poor outcomes.

Methods

A retrospective analysis of 100 patients treated surgically for sICH at Haukeland University Hospital between 2013 and 2022 was conducted. Baseline characteristics and clinical outcomes were collected. Functional outcomes were assessed using the modified Rankin Scale (mRS) at three months post-surgery. Independent risk factors for unfavorable outcomes (mRS ≥4) were identified through logistic regression.

Results

The mean age was 65.5 years (56 % males). At three months, 54 % of patients had an unfavorable outcome, including a 23 % mortality rate. Independent risk factors for poor outcomes included age ≥60 years (OR 7.8, 95 % CI 1.684–36.3, p = 0.009), oral anticoagulant use (OR 10.4, 95 % CI 1.495–72.665, p = 0.018), and hemorrhage location in the basal ganglia (OR 18.5, 95 % CI 3.398–100.717, p < 0.001) or motor cortex (OR 8.6, 95 % CI 2.134–34.973, p = 0.003). These factors formed the basis of a new scoring system—the HeMAtOma score—which demonstrated good discriminatory ability (AUC 0.688) for predicting outcomes.

Conclusion

Functional outcomes following surgical treatment for sICH remain poor in many cases. The HeMAtOma score provides a practical tool for predicting surgical outcomes, aiding clinical decision-making in emergency settings. Future prospective studies are needed to validate the score.