It’s bad, but some do well
ICH has a 30 day mortality of >40%, and only 20% of survivors are functionally independent at 6 months
Early death is usually from a brain herniation syndrome or treatment withdrawal in the context of poor prognosis
Caution is advised about prognosticating too early (<48 hours).
Death in this context may become a self-fulfilling prophecy.
Two prognostic scoring systems exist.
Note that these are intended as baseline severity scores to aid communication among healthcare providers and with patients and their families.
They are NOT to predict exactly how an individual patient will recover.
The ICH score gives mortality estimates.
The FUNC score gives functional independence estimates.
You’ll see from the scores that the biggest predictors of outcome are:
- Initial GCS
- Volume of ICH
- Presence of IVH (worse)
- Age
- Infratentorial ICH (worse)
- Pre-existing cognitive impairment
Factors like pre-existing comorbidities, concomitant issues (e.g. aspiration pneumonitis) and complications of admission, as well as the expressed views of the patient about living with disability or dependence will also affect prognosis.
The degree of disability that is acceptable to individuals varies widely and understanding of patient’s wishes critically informs decisions around their care.