Primary pontine hemorrhage in the acute stage: clinical features and a proposed new simple scoring system.
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.
Department of Neurological Surgery, Hiroshima City Hospital, Hiroshima, Japan. Electronic address: tmeguron@hotmail.com.
Toshinari
T
Meguro
Department of Neurological Surgery, Hiroshima City Hospital, Hiroshima, Japan.
Ken
K
Kuwahara
Department of Neurological Surgery, Hiroshima City Hospital, Hiroshima, Japan.
Yusuke
Y
Tomita
Department of Neurological Surgery, Hiroshima City Hospital, Hiroshima, Japan.
Yu
Y
Okuma
Department of Neurological Surgery, Hiroshima City Hospital, Hiroshima, Japan.
Tomoyuki
T
Tanabe
Department of Neurological Surgery, Hiroshima City Hospital, Hiroshima, Japan.
Kenichiro
K
Muraoka
Department of Neurological Surgery, Hiroshima City Hospital, Hiroshima, Japan.
Kinya
K
Terada
Department of Neurological Surgery, Hiroshima City Hospital, Hiroshima, Japan.
Nobuyuki
N
Hirotsune
Department of Neurological Surgery, Hiroshima City Hospital, Hiroshima, Japan.
Shigeki
S
Nishino
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D001786:Blood Glucose; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011149:Pons / Q000473:pathology*; D012372:ROC Curve; D012025:Reflex, Pupillary / Q000502:physiology; D012189:Retrospective Studies; D012720:Severity of Illness Index
D001786:Blood Glucose
Primary pontine hemorrhage; mortality; outcome; prognosis