Determinants of the in-hospital Outcome of Spontaneous ICH in a Developing Country in the CT Era: a Neurosurgical Prospective Analytical Study.

Introduction: As in most low-middle income countries (LMIC) there is dearth of original reports on the outcome of spontaneous intracerebral haemorrhage (sICH) from sub-Saharan Africa (SSA). Methods: This is a 5-year prospective consecutive study of cases of sICH referred for operative care in an SSA neurosurgeon's practice. The in-hospital outcome was assessed and the determinants thereof were interrogated using univariate and multivariate logistic regression analyses. Results: There were 63 subjects, 38 (60.3%) males, aged 28-85years, mean 55.7 (SD, 12.7). Clinical presentation was in poor prognostic stage in most: >57% in coma; significant mass effect on brain CT in 78.3% and associated IVH in 65%. Surgical evacuation of ICH was offered 23 patients (36.5%), more likely in those with mass effect on CT. In-hospital mortality was 62.3%, and good outcome on dichotomized mRS- 27.4%. These proportions were similar between the surgical and non-surgical patient sub-groups. On univariate analysis, statistically significant clinical-radiological associations of these outcomes (p<0.05 in each case) include presentation in coma, unadjusted OR (95% CI) 24.73 (4.90-124.90); in state of critical illness, 28.00 (6.58-119.23); with respiratory distress/aspiration pneumonitis, 12.31 (3.04-49.77), and ICH with associated IVH, 6.48 (1.86-22.61). On multivariate binary logistic regression analysis, only presentation in a state of critical illness was predictive of death, adjusted OR 97.32(3.67-2583.93, p <0.01). Conclusion: In this typical sub-Sahara African LMIC, spontaneous ICH presents in poor prognostic mode, with coma and general critical illness. In-hospital outcome was poor in this study subjects, notwithstanding the definitive treatment, with / without surgery, received. [ABSTRACT FROM AUTHOR]