Table 2.

Summary of recommendations—neuroprognostication following intracerebral hemorrhage

GOOD PRACTICE STATEMENTS

Aside from the most clinically devastated patients, neuroprognostication for patients with ICH should in general be deferred for at least the first 48–72 h of ICU admission (conditional recommendation, evidence not graded).

Factors such as preexisting cognitive impairment, poor baseline level of functioning, preexisting illness associated with limited life-expectancy, and multiorgan failure are considered at the time of prognostication. These factors are distinct from the scope of these guidelines (strong recommendation, evidence not graded).

Long term cognitive and psychological impairments are common among patients with ICH who do not necessarily meet criteria for a poor functional outcome. Care should be taken during counseling of individual patients’ families to understand what outcomes would have been most valued by the patient (strong recommendation, evidence not graded).

Patients and surrogates should be counseled that ultimate neurological recovery among patients with ICH may occur over a variable period of time, from several days to several months or years (strong recommendation, evidence not graded).

PREDICTORS OF POOR FUNCTIONAL OUTCOME AT 3 MONTHS OR LATER

Clinical Variables

Age

When counseling patients with ICH or their surrogates, we suggest the patient’s age alone not be considered a reliable predictor of poor functional outcome assessed at 3 months or later (weak recommendation; very low quality evidence).

Clinical exam on admission

When counseling patients with ICH or their surrogates, we suggest the patient’s clinical exam on admission alone not be considered a reliable predictor of poor functional outcome assessed at 3 months or later (weak recommendation; low quality evidence).

ICH volume on admission

When counseling patients with ICH or their surrogates, we suggest the patient’s ICH volume on admission alone not be considered a reliable predictor of poor functional outcome assessed at 3 months or later (weak recommendation; low quality evidence).

Infratentorial location

When counseling patients with ICH or their surrogates, we suggest that an infratentorial location alone of the patient’s ICH not be considered a reliable predictor of poor functional outcome assessed at 3 months or later (weak recommendation; low quality evidence).

Intraventricular hemorrhage

When counseling patients with ICH or their surrogates, we suggest that the presence of intraventricular hemorrhage on admission alone not be considered a reliable predictor of poor functional outcome assessed at 3 months or later (weak recommendation; low quality evidence).

Anticoagulation

When counseling patients with ICH or their surrogates, we suggest that anticoagulation at the time of the patient’s ICH onset alone not be considered a reliable predictor of poor functional outcome assessed at 3 months or later (weak recommendation; low quality evidence).

Clinical Grading Scales

Original ICH score

When counseling patients with ICH or their surrogates, we suggest that the patient’s “original” ICH Score not be considered a reliable predictor of poor functional outcome at 3 months and beyond (weak recommendation; low quality evidence).

Max-ICH score

When counseling patients with ICH or their surrogates, we suggest that the patient’s max-ICH Score not be considered a reliable predictor of poor functional outcome at 3 months and beyond (weak recommendation; low quality evidence).

PREDICTORS OF 30-DAY MORTALITYa

Clinical Grading Scalesb

Original ICH score

When counseling patients with ICH or their surrogates, we suggest that the patient’s “original” ICH Score not be considered a reliable predictor of mortality at 30 days (weak recommendation; very low quality evidence).

ICH intracerebral hemorrhage, ICU intensive care unit

^aRecommendations for individual clinical variables as predictors of 30-day mortality are summarized in Supplementary Appendix 3. Similar to prediction of functional outcome at 3 months or later, the panel suggested that none of the individual variables were reliable on their own for 30-day mortality prediction

^bThere was not sufficient evidence to generate a formal recommendation on utilizing the max-ICH score for prediction of 30-day mortality