Development and validation of a clinical prediction model for prognostic factors in patients with primary pontine hemorrhage

Abstract We aimed to develop a prognostic model for primary pontine hemorrhage (PPH) patients and validate the predictive value of the model for a good prognosis at 90 days. A total of 254 PPH patients were included for screening of the independent predictors of prognosis, and data were analyzed by univariate and multivariable logistic regression tests. The cases were then divided into training cohort (n=219) and validation cohort (n=35) based on the two centers. A nomogram was developed using independent predictors from the training cohort to predict the 90-day good outcome and was validated from the validation cohort. Glasgow Coma Scale score, normalized pixels (used to describe bleeding volume), and mechanical ventilation were significant predictors of a good outcome of PPH at 90 days in the training cohort (all P<0.05). The U test showed no statistical difference (P=0.892) between the training cohort and the validation cohort, suggesting the model fitted well. The new model showed good discrimination (area under the curve=0.833). The decision curve analysis of the nomogram of the training cohort indicated a great net benefit. The PPH nomogram comprising the Glasgow Coma Scale score, normalized pixels, and mechanical ventilation may facilitate predicting a 90-day good outcome.

Primary Pontine Hemorrhage. An Analysis of 35 Cases and Research in Prognostic Factors / 대한뇌혈관외과학회지

OBJECTIVE: Primary pontine hemorrhage (PPH) accounts approximately for about 5~10% of intracranial hemorrhages, and overall mortality rate in recent studies is 40~50%. In a general way, primary treatment of PPH is conservative. Although some authors are trying to surgical treatment for PPH recently, treatment guideline still remains controversy. We report our study to establish the clinical and radiologic prognostic factors in PPH patients and present the guideline for surgical treatment. METHODS: We analyzed 35 patients with PPH admitted to our hospital between January 2000 and December 2006. Glasgow Coma Scale (GCS) scores were assessed on admission, and Glasgow Outcome Scale (GOS) scores on discharge. We divided the patients into two groups according to GOS score: (1) patients who had bad prognosis, and (2) patients who had good one. The two groups were compared for age, gender, hypertension, initial GCS, pupillary abnormalities, volume and location of hemorrhage, intraventricular and extrapontine extension, need for mechanical ventilation and hydrocephalus. RESULTS: Twenty-one patients (60%) were hypertensive. Twenty patients (57%) survived and six of them were capable of performing activities of daily living within 3 months of the hemorrhage. Significant prognostic factors were found with coma on admission, GCS score on admission, hematoma location, hematoma volume, need for mechanical ventilation and intraventricular hemorrhage. CONCLUSION: Initial GCS score, size and location of the hematoma, coma on admission, need for mechanical ventilation and intraventricular extension were significantly correlated to poor outcome in our study. If more large studies follow up including surgical outcome, we could make a surgical indication for PPH to improve the mortality and prognosis.

Clinical Analysis of Primary Pontine Hemorrhage

We have experienced 80 cases of primary pontine hemorrhage who were admitted to Kyung Hee Medical Center from October 1982 to September 1987. All cases were confirmed by brain CT scan and treated conservatively. The hematomas have classified according to their modes of extension on computerized tomography. The outcome was assessed on their basis of activity of daily living. The results were as follows: 1) Pontine hemorrhage represented 7.8% of all primary intracerebral hemorrhages. 2) Age distribution was ranged from 3rd decade to 7th decade, and 65% of them were in 4th and 5th decade. The ratio of male to female was 5:3. 3) 91.2% of patients had history of systemic hypertension and most of them did not received antihypertensive medication. 85% of patients showed the systolic blood pressure on admission above 160mmHg. 4) Outcome I and II according to ADL were only .5%. The prognosis was affected by level of consciousness, blood pressure on admission, and size and extent of hemorrhage. 5) Majority of causes of death were injury to brain itself, and the mortality rate was 33.7%.

Clinical Analysis of Primary Pontine Hemorrhage

We have experienced 80 cases of primary pontine hemorrhage who were admitted to Kyung Hee Medical Center from October 1982 to September 1987. All cases were confirmed by brain CT scan and treated conservatively. The hematomas have classified according to their modes of extension on computerized tomography. The outcome was assessed on their basis of activity of daily living. The results were as follows: 1) Pontine hemorrhage represented 7.8% of all primary intracerebral hemorrhages. 2) Age distribution was ranged from 3rd decade to 7th decade, and 65% of them were in 4th and 5th decade. The ratio of male to female was 5:3. 3) 91.2% of patients had history of systemic hypertension and most of them did not received antihypertensive medication. 85% of patients showed the systolic blood pressure on admission above 160mmHg. 4) Outcome I and II according to ADL were only .5%. The prognosis was affected by level of consciousness, blood pressure on admission, and size and extent of hemorrhage. 5) Majority of causes of death were injury to brain itself, and the mortality rate was 33.7%.