Standardizing Prognostication and Management of Spontaneous Basal Ganglia Hemorrhage: A Novel Scoring System

Background: Factors that are used in spontaneous ICH prognostication score cannot be generalized to basal ganglia haemorrhages. Our study aimed in developing a novel scoring system for prognosticating and management of basal ganglia haemorrhages, including factors likely to influence mortality or survival. Methods: : A prospective study was performed of 351 patients with spontaneous basal ganglia haemorrhage. The patients were either managed conservatively or underwent operative intervention. Mortality at 90 days was recorded. Using univariate and multivariable logistic regression, the association between various plausible factors and 90-day mortality was tested. Factors found to be significant were used to develop a novel scoring system and the association between 90-day mortality and modified ICH score was calculated. This score was subsequently used to standardize the management with a score correlation to treatment guidelines, thus advocating either conservative or operative management depending upon the score. Thus based on this scoring system, we tried to develop a range below which conservative management was advisable, a score favouring operative intervention, and a score above which operative intervention was futile, since both conservative and surgical treatment resulted in the same outcome. Results: : We analyzed 339 cases, overall, 90-day mortality was 37.75% (n=128). The survival rate in patients having modified ICH score of 7 or less than 7 was 91.66%, however, it decreased to 12.19% in patients having a score > 7. A modified ICH score of 7 or less than 7 could predict the survival in 93.8% (95% CI 89.7-96.7) of patients and had a specificity of 85.9%%. The positive predictive value of modified ICH score 7 or < 7 was 91.7% (95%CI 87.1-95.0). In patients with score of 6, surgery was advisable in almost 50% of cases and the mortality was 100 percent even after surgical intervention in patients having score of 10 or more. Conclusion: Modified ICH score is a useful tool for predicting 90-days mortality, the area under the ROC curve was 93% which was higher than any other studies for spontaneous ICH. This scoring system can also aid in deciding the line of management of basal ganglia bleed patients. Trial registration: retrospectively registered