Introduction: Intracerebral hemorrhages (ICH) carry the highest rates of morbidity and mortality of the stroke subtypes despite advances in medical and surgical care. Many current grading scales only take into account factors such as size of hemorrhage, neurologic exam, and age. These scales do not consider the patient’s pre-hemorrhage medical comorbidities. One model of frailty suggests that there is decreased reserve in multiple organ systems due to accumulating deficits. The modified frailty index (mFI) consists of 11 items and has been previously shown in multiple surgical subspecialties to correlate with morbidity and mortality for each unit increase. This study aims to analyze whether there is a similar correlation between mFI and ICH mortality rates.
Methods: A retrospective review of all patients admitted to the neurosurgical service with intracerebral hemorrhage between September 2015 and September 2017 was conducted. The electronic medical records were analyzed to identify mFI components and in-hospital mortality rates.
Results: 209 patients were identified and the preliminary data on 54 patients shows that increasing frailty is associated with worse morbidity and mortality. 11.1% (6/54) had an mFI of 0, 18.5% (10/54) an mFI of 1, 22.2% (12/54) an mFI of 2, 20.3% (11/54) an MFI of 3, 22.2% (12/54) an mFI of 4, and 5.6% (3/54) an mFI of 5. When grouped into robust (mFI of 0), pre-frail (mFI 1-2), and frail (mFI =3), there was an association with increasing mortality rates. There was a mortality rate of 16.7% (1/6) in robust patients, 27.3% (6/22) in prefrail, and 38.5% in frail (10/26).
Conclusions: There are numerous scores including the FUNC and ICH scores that predict morbidity and mortality after spontaneous intracerebral hemorrhages. The mFI adds another element that can be used to assess the patient and predict the mortality rate.
Patient Care: By giving physicians additional information to properly assess their patients and discuss prognosis in a devastating disease.
Learning Objectives: To demonstrate that a patient's pre-hemorrhage state can influence their outcomes from a intracerebral hemorrhage