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.
(Less)
- author
- Tsitsopoulos, Parmenion P
; Enblad, Per
; Wanhainen, Anders
; Tobieson, Lovisa
; Hårdemark, Hans-Göran
and Marklund, Niklas
LU
- publishing date
- 2013-11
- type
- 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
-
- pmid:24026230
- 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
- 2024-01-04 18:26:45
@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 < 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).</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}},
keywords = {{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}},
doi = {{10.1007/s00701-013-1871-1}},
volume = {{155}},
year = {{2013}},
}