Association between brain computer tomography findings and functional outcomes among adults with non-traumatic intracranial hemorrhage at Moi Teaching and Referral Hospital

Abstract

Background: Intracranial hemorrhage (ICH) is an important medical event associated with stroke globally. Worldwide the incidence and mortality of ICH is increasing in the low- and middle-income countries as compared to the high-income countries. Non-contrast computerized tomography (CT) is the most widely used and readily available tool for diagnosis of intracranial hemorrhage. It has a rapid acquisition of images and high accuracy for detecting intracranial hemorrhage. The modified Rankin Scale is a reliable, easy to use tool for assessing the functional outcomes of post-stroke cases. There is paucity of data on the association of brain CT findings and functional outcomes in our setting. Therefore, this study seeks to describe brain CT findings and functional outcomes among adults with non-traumatic intracranial hemorrhage. Objectives: To describe brain CT findings, functional outcome and determine their associations among adults with non-traumatic intracranial hemorrhage at MTRH. Methods: This study was a prospective cohort study conducted among adult patients at MTRH from December 2021 to November 2022. A census sampling was used to recruit 97 participants who were eligible. A data collection tool was used to record age, gender, brain CT findings and outcomes at 30 days. The modified Rankin Scale was used to score the 30-day functional outcome. The participants were scanned using the Siemens 32 slice CT. Continuous variables were analyzed using mean, median, and their corresponding standard deviation and interquartile ranges while categorical variables were summarized as proportions and percentages. The Mood‘s median test, Chi square test and the logistics regression models were used to test for association between Brain CT findings and functional outcomes. A P-value of less than 0.05 was considered significant. Results: Most of the study participants were male at 52.6%, aged more than 50 years with a mean age 59.09 (14.43). Intracerebral hemorrhage was supratentorial on brain CT in 84 (85.7%) study participants. ICH was observed in the lobar (44.3%), deep lobar (41.2%), cerebellar (9.3%), brain stem (3.1%) and the 4th ventricle (2.1%). 73.2% of the study participants had hematoma volume of less than 30ml, 69.1%, 89.7% and 17.5 % had associated mass effect, edema, and cerebral herniation respectively. The median modified ranking score was 4 (IQR: 3-6) and 57.7% of the participants had poor outcome. On multivariable analysis, the presence of mass effect (OR=40.06, CI: 1.61 - 994.90, p-value=0.024) and cerebral herniation (OR= 81.79 CI: 8.25 - 810.62, p-value <0.001) were statistically significant predictors of 30-day mortality. Conclusion: Majority of the patients had intracerebral hemorrhage in the supratentorial region and less than 30 ml hematoma volume. The median modified ranking score was 4 and slightly more than half of the participants had poor functional outcome. Hematoma volume more than 30 ml, presence of mass effect and herniation were significantly associated with poor outcome and higher odds observed with mass effect and herniation. Recommendation: A longer duration study with more participants to ascertain the strength of association.