Primary Pontine Hemorrhage in the Acute Stage: Clinical Features and a Proposed New Simple Scoring System

• Published in: Journal of stroke and cerebrovascular diseases Vol. 24; no. 4; pp. 860 - 865
• Main Authors: Meguro, Toshinari, MD, Kuwahara, Ken, MD, Tomita, Yusuke, MD, Okuma, Yu, MD, Tanabe, Tomoyuki, MD, Muraoka, Kenichiro, MD, Terada, Kinya, MD, Hirotsune, Nobuyuki, MD, Nishino, Shigeki, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Acute Disease; Adult; Age Factors; Aged; Blood Glucose; Cardiovascular; Female; Glasgow Coma Scale; Humans; Intracranial Hemorrhages - diagnosis; Intracranial Hemorrhages - mortality; Intracranial Hemorrhages - physiopathology; Male; Middle Aged; mortality; Neurology; outcome; Pons - pathology; Primary pontine hemorrhage; prognosis; Reflex, Pupillary - physiology; Retrospective Studies; ROC Curve; Severity of Illness Index; mortality; prognosis; Primary pontine hemorrhage; outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2014.12.006

Background It is important to evaluate the likelihood of fatality in patients with acute primary pontine hemorrhage (PPH) in emergency departments. We aimed to evaluate the clinical symptoms and computed tomography findings of PPH to develop a simple grading scale for predicting the mortality of PPH. Methods Records of 101 consecutive patients admitted to our hospital with acute PPH between June 1, 2006, and January 31, 2014, were retrospectively reviewed. Independent predictors of 30-day mortality were identified by univariate and multivariate logistic regression analyses. A simple and easy clinical score (PPH score) was developed from independent factors to predict mortality in acute PPH. The PPH score was compared with the established intracerebral hemorrhage (ICH) score, which served as the reference scoring system. Results Overall mortality rate 30 days after onset was 58.4% (59 of 101). Factors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score of 6 or less ( P  = .0051), absence of pupillary light reflex ( P  = .0003), and blood glucose of 180 mg/dL or greater ( P  = .0312). The PPH score was the sum of independent factors, which were assigned 1 point each. The area under the receiver operating characteristic curve for predicting 30-day mortality was .90 (95% confidence interval [CI], .84-.95) for PPH score and .86 (95% CI, .78-.93) for ICH score. Conclusions GCS score of 6 or less, absence of pupillary light reflex, and plasma glucose of 10 mmol/L or greater are independent mortality predictors of PPH. The PPH score is a simple and reliable clinical grading scale for predicting 30-day mortality.