Raffaele Ornello, MD

Lun R, Yogendrakumar V, Demchuk AM, Aviv RI, Rodriguez-Luna D, Molina CA, et al. Calculation of Prognostic Scores, Using Delayed Imaging, Outperforms Baseline Assessments in Acute Intracerebral Hemorrhage. Stroke. 2020;51:1107–1110.

The prognosis of intracerebral hemorrhage (ICH) is poor, and it is hard to identify factors which can predict a good or bad outcome. Besides, ICH is usually a fast-progressing clinical picture, in which early and delayed imaging may show completely different pictures.

The multicenter, prospective, observational cohort of the PREDICT study (Prediction of Hematoma Growth and Outcome in Patients With Intracerebral Hemorrhage Using the CT-Angiography Spot Sign) included 280 patients with a 90-day case-fatality of 25%. The study assessed the predictive accuracy for 90-day mortality of the ICH Score, FUNC Score, and modified ICH Score using imaging data at initial presentation and at 24 hours. Analyses were performed using receiver operating characteristic curves. Compared with early imaging, brain imaging performed 24 hours after ICH onset significantly improved the accuracy of prognostic scores; in detail, the area under the curve increased from 0.78 to 0.82 for ICH score, from 0.76 to 0.84 for FUNC Score, and from 0.74 to 0.82 for modified ICH score. The study findings are limited by the absence of complete 24-hour clinical data. Nevertheless, the study points out that waiting 24 hours from symptom onset might improve the prediction of ICH prognosis.

A possible consequence of this study is that early withdrawal of ICH care might be unjustified, as physicians can provide reliable estimates of patients’ prognosis only after several hours from ICH onset. More interventions in the hyperacute phase of ICH might be needed, and several studies suggest the efficacy of such early interventions. Waiting 24 hours before withdrawing care might be a viable option in ICH.