Zahuranec D B, Gonzales N R, Brown D L, Lisabeth L D, Longwell P J, Eden S V, Smith M A, Garcia N M, Hoff J T, Morgenstern L B
Stroke Program, University of Michigan Medical School, Ann Arbor, MI 48109-0316, USA.
J Neurol Neurosurg Psychiatry. 2006 Mar;77(3):340-4. doi: 10.1136/jnnp.2005.077164.
Studies on intracerebral haemorrhage (ICH) from tertiary care centres may not be an accurate representation of the true spectrum of disease presentation.
To describe the clinical and imaging presentation of ICH in a community devoid of the referral bias of an academic medical centre; and to investigate factors associated with lower Glasgow coma scale (GCS) score at presentation, as GCS is crucial to early clinical decision making.
The study formed part of the BASIC project (Brain Attack Surveillance in Corpus Christi), a population based stroke surveillance study in a bi-ethnic Texas community. Cases of first non-traumatic ICH were identified from years 2000 to 2003, using active and passive surveillance. Clinical data were collected from medical records by trained abstractors, and all computed tomography (CT) scans were reviewed by a study physician. Multivariable linear regression was used to identify clinical and CT predictors of a lower GCS score.
260 cases of non-traumatic ICH were identified. Median ICH volume was 11 ml (interquartile range 3 to 36) with hydrocephalus noted in 45%. Median initial GCS score was 12.5 (7 to 15). Hydrocephalus score (p = 0.0014), ambient cistern effacement (p = 0.0002), ICH volume (p = 0.014), and female sex (p = 0.024) were independently associated with lower GCS score at presentation, adjusting for other variables.
ICH has a wide range of severity at presentation. Hydrocephalus is a potentially reversible cause of a lower GCS score. Since early withdrawal of care decisions are often based on initial GCS, recognition of the important influence of hydrocephalus on GCS is warranted before withdrawal of care decisions are made.
来自三级医疗中心的脑出血（ICH）研究可能无法准确反映疾病表现的真实范围。
描述在一个没有学术医疗中心转诊偏倚的社区中ICH的临床和影像学表现；并调查与入院时格拉斯哥昏迷量表（GCS）评分较低相关的因素，因为GCS对早期临床决策至关重要。
该研究是BASIC项目（科珀斯克里斯蒂脑卒中考察）的一部分，这是一项在德克萨斯州一个双种族社区进行的基于人群的卒中监测研究。2000年至2003年期间，通过主动和被动监测确定了首例非创伤性ICH病例。训练有素的摘要员从医疗记录中收集临床数据，所有计算机断层扫描（CT）扫描均由研究医生进行复查。采用多变量线性回归来确定GCS评分较低的临床和CT预测因素。
共确定了260例非创伤性ICH病例。ICH体积中位数为11毫升（四分位间距3至36），45%的病例出现脑积水。初始GCS评分中位数为12.5（7至15）。在对其他变量进行校正后，脑积水评分（p = 0.0014）、脑池受压（p = 0.0002）、ICH体积（p = 0.014）和女性（p = 0.024）与入院时较低的GCS评分独立相关。
ICH在发病时严重程度范围广泛。脑积水是导致GCS评分较低的一个潜在可逆原因。由于早期的撤机决策通常基于初始GCS评分，因此在做出撤机决策之前，有必要认识到脑积水对GCS的重要影响。
