title: Full medical support for intracerebral hemorrhage.
abstract: OBJECTIVE
  This study tested the hypothesis that patients without placement of new do-not-resuscitate (DNR) orders during the first 5 days after intracerebral hemorrhage (ICH) have lower 30-day mortality than predicted by the ICH Score without an increase in severe disability at 90 days.
  
  
  METHODS
  This was a prospective, multicenter, observational cohort study at 4 academic medical centers and one community hospital. Adults (18 years or older) with nontraumatic spontaneous ICH, Glasgow Coma Scale score of 12 or less, who did not have preexisting DNR orders were included.
  
  
  RESULTS
  One hundred nine subjects were enrolled. Mean age was 62 years; median Glasgow Coma Scale score was 7, and mean hematoma volume was 39 cm(3). Based on ICH Score prediction, the expected overall 30-day mortality rate was 50%. Observed mortality was substantially lower at 20.2%, absolute average difference 29.8% (95% confidence interval: 21.5%-37.7%). At 90 days, 27.1% had died, 21.5% had a modified Rankin Scale score = 5 (severe disability). A good outcome (modified Rankin Scale score 0-3) was achieved by 29.9% and an additional 21.5% fell into the moderately severe disability range (modified Rankin Scale score = 4).
  
  
  CONCLUSIONS
  Avoidance of early DNR orders along with guideline concordant ICH care results in substantially lower mortality than predicted. The observed functional outcomes in this study provide clinicians and families with data to determine the appropriate goals of treatment based on patients' wishes.
authors.affiliation: From Stroke Program, Department of Neurology (L.B.M., D.B.Z., R.H.), and Department of Neurosurgery (L.B.M.), University of Michigan Health System, Ann Arbor; Departments of Epidemiology (L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor; Department of Neurology (K.J.B.), University of Washington School of Medicine, Seattle; Department of Neurology (M.G.), Providence Sacred Heart Hospital, Spokane, WA; Department of Neurology (G.N.), Wayne State School of Medicine, Detroit, MI; Departments of Neurology (J.C.H.) and Neurological Surgery (J.C.H.), University of California, San Francisco School of Medicine. lmorgens@umich.edu.
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
authors.affiliation: From Stroke Program, Department of Neurology (L.B.M., D.B.Z., R.H.), and Department of Neurosurgery (L.B.M.), University of Michigan Health System, Ann Arbor; Departments of Epidemiology (L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor; Department of Neurology (K.J.B.), University of Washington School of Medicine, Seattle; Department of Neurology (M.G.), Providence Sacred Heart Hospital, Spokane, WA; Department of Neurology (G.N.), Wayne State School of Medicine, Detroit, MI; Departments of Neurology (J.C.H.) and Neurological Surgery (J.C.H.), University of California, San Francisco School of Medicine.
authors.forename: Darin B
authors.initials: DB
authors.lastname: Zahuranec
authors.affiliation: From Stroke Program, Department of Neurology (L.B.M., D.B.Z., R.H.), and Department of Neurosurgery (L.B.M.), University of Michigan Health System, Ann Arbor; Departments of Epidemiology (L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor; Department of Neurology (K.J.B.), University of Washington School of Medicine, Seattle; Department of Neurology (M.G.), Providence Sacred Heart Hospital, Spokane, WA; Department of Neurology (G.N.), Wayne State School of Medicine, Detroit, MI; Departments of Neurology (J.C.H.) and Neurological Surgery (J.C.H.), University of California, San Francisco School of Medicine.
authors.forename: Brisa N
authors.initials: BN
authors.lastname: Sánchez
authors.affiliation: From Stroke Program, Department of Neurology (L.B.M., D.B.Z., R.H.), and Department of Neurosurgery (L.B.M.), University of Michigan Health System, Ann Arbor; Departments of Epidemiology (L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor; Department of Neurology (K.J.B.), University of Washington School of Medicine, Seattle; Department of Neurology (M.G.), Providence Sacred Heart Hospital, Spokane, WA; Department of Neurology (G.N.), Wayne State School of Medicine, Detroit, MI; Departments of Neurology (J.C.H.) and Neurological Surgery (J.C.H.), University of California, San Francisco School of Medicine.
authors.forename: Kyra J
authors.initials: KJ
authors.lastname: Becker
authors.affiliation: From Stroke Program, Department of Neurology (L.B.M., D.B.Z., R.H.), and Department of Neurosurgery (L.B.M.), University of Michigan Health System, Ann Arbor; Departments of Epidemiology (L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor; Department of Neurology (K.J.B.), University of Washington School of Medicine, Seattle; Department of Neurology (M.G.), Providence Sacred Heart Hospital, Spokane, WA; Department of Neurology (G.N.), Wayne State School of Medicine, Detroit, MI; Departments of Neurology (J.C.H.) and Neurological Surgery (J.C.H.), University of California, San Francisco School of Medicine.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Geraghty
authors.affiliation: From Stroke Program, Department of Neurology (L.B.M., D.B.Z., R.H.), and Department of Neurosurgery (L.B.M.), University of Michigan Health System, Ann Arbor; Departments of Epidemiology (L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor; Department of Neurology (K.J.B.), University of Washington School of Medicine, Seattle; Department of Neurology (M.G.), Providence Sacred Heart Hospital, Spokane, WA; Department of Neurology (G.N.), Wayne State School of Medicine, Detroit, MI; Departments of Neurology (J.C.H.) and Neurological Surgery (J.C.H.), University of California, San Francisco School of Medicine.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hughes
authors.affiliation: From Stroke Program, Department of Neurology (L.B.M., D.B.Z., R.H.), and Department of Neurosurgery (L.B.M.), University of Michigan Health System, Ann Arbor; Departments of Epidemiology (L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor; Department of Neurology (K.J.B.), University of Washington School of Medicine, Seattle; Department of Neurology (M.G.), Providence Sacred Heart Hospital, Spokane, WA; Department of Neurology (G.N.), Wayne State School of Medicine, Detroit, MI; Departments of Neurology (J.C.H.) and Neurological Surgery (J.C.H.), University of California, San Francisco School of Medicine.
authors.forename: Gregory
authors.initials: G
authors.lastname: Norris
authors.affiliation: From Stroke Program, Department of Neurology (L.B.M., D.B.Z., R.H.), and Department of Neurosurgery (L.B.M.), University of Michigan Health System, Ann Arbor; Departments of Epidemiology (L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor; Department of Neurology (K.J.B.), University of Washington School of Medicine, Seattle; Department of Neurology (M.G.), Providence Sacred Heart Hospital, Spokane, WA; Department of Neurology (G.N.), Wayne State School of Medicine, Detroit, MI; Departments of Neurology (J.C.H.) and Neurological Surgery (J.C.H.), University of California, San Francisco School of Medicine.
authors.forename: J Claude
authors.initials: JC
authors.lastname: Hemphill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016414:Resuscitation Orders; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
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