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Improved outcome of patients with severe thalamic hemorrhage treated with cerebrospinal fluid drainage and neurocritical care during 1990-1994 and 2005-2009

Tsitsopoulos, Parmenion P; Enblad, Per; Wanhainen, Anders; Tobieson, Lovisa; Hårdemark, Hans-Göran and Marklund, Niklas LU (2013) In Acta Neurochirurgica 155(11). p.13-2105
Abstract

INTRODUCTION: Patients with thalamic hemorrhage, depressed level of consciousness and/or signs of elevated intracranial pressure may be treated with neurocritical care (NCC) and external ventricular drainage (EVD) for release of cerebrospinal fluid.

METHODS: Forty-three patients with thalamic hemorrhage treated with NCC from 1990 to 1994 (n = 21) and from 2005-2009 (n = 22) were evaluated. Outcome was assessed using the Glasgow Coma Scale (GCS) score at discharge from our unit and the modified Rankin Scale (mRS) for long-term outcome.

RESULTS: Patients' age was 59.5 ± 7 years in 1990-1994, and 58.2 ± 9 years in 2005-2009. The median (25th and 75th percentile) GCS score on admission for the two time periods was 9 (6-12) and 9... (More)

INTRODUCTION: Patients with thalamic hemorrhage, depressed level of consciousness and/or signs of elevated intracranial pressure may be treated with neurocritical care (NCC) and external ventricular drainage (EVD) for release of cerebrospinal fluid.

METHODS: Forty-three patients with thalamic hemorrhage treated with NCC from 1990 to 1994 (n = 21) and from 2005-2009 (n = 22) were evaluated. Outcome was assessed using the Glasgow Coma Scale (GCS) score at discharge from our unit and the modified Rankin Scale (mRS) for long-term outcome.

RESULTS: Patients' age was 59.5 ± 7 years in 1990-1994, and 58.2 ± 9 years in 2005-2009. The median (25th and 75th percentile) GCS score on admission for the two time periods was 9 (6-12) and 9 (4-14), respectively. Long-term follow-up was assessed at a mean of 37.1 (range 19-65) months after disease onset for the 1990-1994 cohort and at 37.4 (range 14-58) months for the 2005-2009 cohort. Compared to patients from 1990 to 1994, patients from 2005 to 2009 had a significantly better outcome (median mRS [25th and 75th percentile]: 5 [4-6] vs. 4 [2-4.5]; p < 0.01). Most patients (13/21, 62 %) treated from 1990 to 1994 had unchanged or lower GCS scores during their NCC stay in contrast to 7/22 (32 %) from 2005 to 2009. At the last follow-up, 13/21 (62 %) patients from 1990 to 1994 were dead in comparison to 4/21 (19 %) from 2005 to 2009 (p < 0.05). Negative prognostic factors were the 120 h post-admission GCS score in the 1990-1994 patient cohort (p = 0.07) and high age in the recent cohort (p = 0.04).

CONCLUSIONS: Patients with thalamic hemorrhage and depressed level of consciousness on admission had a worse outcome in the early 1990s compared with the late 2000s, which may at least be partially attributed to refined neurocritical care.

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Contribution to journal
publication status
published
keywords
Adult, Aged, Cerebral Hemorrhage, Drainage, Female, Glasgow Coma Scale, Humans, Intracranial Hypertension, Male, Middle Aged, Prognosis, Thalamic Diseases, Treatment Outcome, Journal Article
in
Acta Neurochirurgica
volume
155
issue
11
pages
9 pages
publisher
Springer
external identifiers
  • scopus:84886402761
ISSN
0001-6268
DOI
10.1007/s00701-013-1871-1
language
English
LU publication?
no
id
005bc510-5d64-41e2-bf34-c55e722ebdf8
date added to LUP
2016-12-08 12:21:41
date last changed
2018-01-07 11:39:54
@article{005bc510-5d64-41e2-bf34-c55e722ebdf8,
  abstract     = {<p>INTRODUCTION: Patients with thalamic hemorrhage, depressed level of consciousness and/or signs of elevated intracranial pressure may be treated with neurocritical care (NCC) and external ventricular drainage (EVD) for release of cerebrospinal fluid.</p><p>METHODS: Forty-three patients with thalamic hemorrhage treated with NCC from 1990 to 1994 (n = 21) and from 2005-2009 (n = 22) were evaluated. Outcome was assessed using the Glasgow Coma Scale (GCS) score at discharge from our unit and the modified Rankin Scale (mRS) for long-term outcome.</p><p>RESULTS: Patients' age was 59.5 ± 7 years in 1990-1994, and 58.2 ± 9 years in 2005-2009. The median (25th and 75th percentile) GCS score on admission for the two time periods was 9 (6-12) and 9 (4-14), respectively. Long-term follow-up was assessed at a mean of 37.1 (range 19-65) months after disease onset for the 1990-1994 cohort and at 37.4 (range 14-58) months for the 2005-2009 cohort. Compared to patients from 1990 to 1994, patients from 2005 to 2009 had a significantly better outcome (median mRS [25th and 75th percentile]: 5 [4-6] vs. 4 [2-4.5]; p &lt; 0.01). Most patients (13/21, 62 %) treated from 1990 to 1994 had unchanged or lower GCS scores during their NCC stay in contrast to 7/22 (32 %) from 2005 to 2009. At the last follow-up, 13/21 (62 %) patients from 1990 to 1994 were dead in comparison to 4/21 (19 %) from 2005 to 2009 (p &lt; 0.05). Negative prognostic factors were the 120 h post-admission GCS score in the 1990-1994 patient cohort (p = 0.07) and high age in the recent cohort (p = 0.04).</p><p>CONCLUSIONS: Patients with thalamic hemorrhage and depressed level of consciousness on admission had a worse outcome in the early 1990s compared with the late 2000s, which may at least be partially attributed to refined neurocritical care.</p>},
  author       = {Tsitsopoulos, Parmenion P and Enblad, Per and Wanhainen, Anders and Tobieson, Lovisa and Hårdemark, Hans-Göran and Marklund, Niklas},
  issn         = {0001-6268},
  keyword      = {Adult,Aged,Cerebral Hemorrhage,Drainage,Female,Glasgow Coma Scale,Humans,Intracranial Hypertension,Male,Middle Aged,Prognosis,Thalamic Diseases,Treatment Outcome,Journal Article},
  language     = {eng},
  number       = {11},
  pages        = {13--2105},
  publisher    = {Springer},
  series       = {Acta Neurochirurgica},
  title        = {Improved outcome of patients with severe thalamic hemorrhage treated with cerebrospinal fluid drainage and neurocritical care during 1990-1994 and 2005-2009},
  url          = {http://dx.doi.org/10.1007/s00701-013-1871-1},
  volume       = {155},
  year         = {2013},
}