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July 25, 2022

Time for a New Perspective on Intracerebral Hemorrhage

Author Affiliations
  • 1Division of Stroke and Cerebrovascular Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
JAMA Neurol. 2022;79(9):844-845. doi:10.1001/jamaneurol.2022.1988

More than 3 million people worldwide experience intracerebral hemorrhage (ICH) each year.1 Although the incidence of ICH is much lower than that of ischemic stroke, ICH imposes a 50% greater worldwide burden of disability.2 ICH has a 30-day case fatality rate of more than 40%, and most survivors are left with permanent disabilities.3 Because of the high likelihood of poor outcomes, physicians caring for patients with ICH tend to use clinical severity scores early on to estimate the risk of mortality or future disability to determine the aggressiveness of medical care and to guide conversations with patients’ surrogates around goals of care. However, it is becoming increasingly recognized that reliance on prognostic scores during the hyperacute phase is neither reliable nor advisable and could be counterproductive owing to the bias of self-fulfilling prophecy.4,5 Prediction of long-term outcomes during the first days of hospitalization does not fully capture the burden of the disease, related complications, and in-hospital interventions.6 A better understanding of the patient characteristics and in-hospital prognostic indicators that influence outcome and the trajectory of recovery after ICH is critical. Most clinical trials in ICH and outcome prediction studies assessed outcomes at or before 90 days, and there is a paucity of prospective systematic data on the trajectory of recovery in ICH beyond 90 days.

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