Modified ICH score was superior to original ICH score for assessment of 30-day mortality and good outcome of non-traumatic intracerebral hemorrhage.

INTRODUCTION: Intracerebral hemorrhage (ICH) score has been widely used as a consistent and reliable clinical grading scale for predicting mortality. However, ICH score had not been used to predict good outcome or significant disability for those who were alive. We intended to address whether any modifications would increase prediction accuracy for mortality as well as the extent of morbidity for those who survived. METHODS: We conducted a retrospective cohort study, involving all non-traumatic ICH patients admitted to our hospital between September 2018 and July 2020. All non-traumatic ICH patients who were admitted to the stroke unit and registered in our stroke database had their medical records, neuroimaging, and laboratory test results reviewed. Only patients with complete medical records and available CT imaging and laboratory test results were included in our study. Independent predictors of mortality (modified Rankin scale/mRS of 6) or good outcome vs. significant disability (mRS≤2 vs. mRS 3-5, respectively) were identified by logistic regression. A modified ICH (mICH) score was compared with the original ICH (oICH) score for its diagnostic performance (DP). Overall DPs were graded and ranked according to Youden Index (YI). RESULTS: As many as 311 patients were eligible with both 39.9% rate of 30-day mortality and good outcome. Factors independently associated with mortality were low GCS and high NIHSS on admission (P = 0.002, <0.001, respectively), and presence of respiratory failure (P < 0.001). Independent factors for good outcome were low NIHSS on admission and mass effect (midline shift > 5 mm) [both P < 0.001]. A modification of ICH score from the original was made by substituting GCS with NIHSS (0 -10 = 1; 11 - 20 = 2; >20 = 3), changing age cut-off point to > 55 years old (= 1), and adding respiratory failure (= 1), and mass effect (= 1). Overall, mICH scored better over oICH score with respect to sensitivity and had comparable specificity for both 30-day mortality and good outcome (sensitivity 80.6% vs. 50.8%; specificity 88.7% vs. 89.3%; YI 0.69 vs. 0.40, respectively) and good outcome (sensitivity 86.3% vs. 77.4%; specificity 74.6% vs. 77.8%; YI of 0.61 vs. 0.55, respectively). There was only one patient with oICH and none on mICH score of 0, who died and none survived with oICH and mICH score of ≥ 5 and ≥ 7, respectively. The proportion of 30-day mortality and good outcome increased in a more linear fashion with mICH score. CONCLUSIONS: The mICH score was proven to be reliable and consistent as a risk grading assessment for non-traumatic ICH patients. The mICH was statistically superior to oICH score in predicting 30-day mortality and good outcome.

Pain as clinical manifestations of COVID-19 infection and its management in the pandemic era: a literature review.

Coronavirus disease 2019 (COVID-19) is a current global pandemic. The case number has increased since December 31, 2019. It has been reported that COVID-19 patients have been giving pain complaints, one of which is muscular pain. Other types of pain that have also been reported by COVID-19 patients are joint pain, stomach pain, and testicular pain. Neuropathic pain is the rarest case among others. COVID-19 mechanisms in the nerve and musculoskeletal damage are believed to be caused by the expression and distribution of angiotensin-converting enzyme 2 (ACE-2). Patients with pain, especially neuropathic pain, normally do not respond well to various therapies, and experience psychiatric disorders such as depression, which leads to a decrease in the patient's quality of life. Important considerations for health professionals in terms of pain management during this pandemic include ensuring treatment continuity, painkillers, utilization of telemedicine, biopsychosocial management approach, and modifying therapy needs to reduce the risks of COVID-19 complications.