General Prognostic Features

The information in the preceding section regarding specific hemorrhage locations is based on observations of small groups of patients. Another approach assesses outcome in larger, more heterogeneous groups (e.g., patients with supratentorial hemorrhage). The potential advantage of the second approach is the ability to apply powerful statistical techniques; however, the ability to collect information such as is collectible with small subgroups might be lost.

Several early studies (26-33) performed only univariate analysis of factors associated with outcome. Age, lesion location, electrocardiographic abnormalities, and hypertensive history were inconsistently associated with prognoses, but shift of midline structures on CT scan was associated with fatal outcome in the two studies that evaluated this finding. Ropper noted an association between level of consciousness and degree of horizontal displacement of the pineal body in acute hemispheral mass lesions, mainly ICHs (34). Level of consciousness is the clinical sign most consistently associated with ICH prognosis. The consistent importance of hemorrhage size, level of consciousness or Glasgow Coma Scale (GCS), and IVH extension mirror the prominent role that these factors play in descriptions of specific hemorrhage types.

Studies that employed multivariate analysis (35 -43) produced fairly consistent results, despite minor variations in patient selection, variables assessed, and statistical methods. The variables identified as independent predictors of outcome in these studies are listed in Table 1.

Hemorrhage size, intraventricular extension of blood, and GCS or level of consciousness emerge as consistent, independent predictors of survival. Midline shift, oxygen saturation, and electrocardiographic abnormalities have been identified in some models, but too infrequently to be included in the table. Serum glucose and age are frequently examined, but with contradictory results.

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