Rinsho Shinkeigaku (Clinical Neurology)

Original Article

Brain hemorrhage with medical treatment: prediction of early outcome and production of critical paths

Kazunori Toyoda, M.D.1), Yasushi Okada, M.D.1), Shigeru Fujimoto, M.D.1), Yasuhiro Hasegawa, M.D.3), Setsuro Ibayashi, M.D.4) and Tooru Inoue, M.D.2)

1)Department of Cerebrovascular Disrease and 2)Neurosurgery, Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center
3)Division of Cerebrovascular Diseases, Department of Internal Medicine, National Cardiovascular Center
4)Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University

The first purpose of this study was to detect clinical and radiological factors on admission which predict early outcome of patients in brain hemorrhage with medical treatment. For 50 consecutive patients in our Cerebrovascular Center, NIH Stroke Scale score was a useful indicator for prediction of independent daily life, discharge to home, and death in the acute stage; the score≤4, ≤7, and ≥23 were the most appropriate cut-off values for the above events, respectively.
The second purpose of this study was to produce critical paths of medical management for brain hemorrhage based on the above results. We prepared three courses of paths according to clinical severity. As inclusion criteria for each course, we used the above three cut-off values and hematoma volume. Duration of hospitalization of the three courses was 16, 20, and 28 days. When we applied the paths to 200 patients with brain hemorrhage who were enrolled in the research grant supported by the Japanese ministry of health, labor and welfare (12C-10), duration of hospitalization for the majority of the patients were 5 days or more than the planned duration in the paths.
It is indispensable to manage acute stroke patients according to critical paths, because standard and efficient strategies of clinical medicine have been stressed these years. We will immediately apply the new paths in this study to patients in our center, and renew them at short intervals. We think that we can contribute to new evidences for standard medical management of brain hemorrhage by our approach to the critical paths.

(CLINICA NEUROL, 44: 342－349, 2004)
key words: brain hemorrhage, functional outcome, NIH Stroke Scale, clinical paths, rehabilitation

(Received: 19-Jul-03)