Intracerebral Hemorrhage-Grading Scale (ICH-GS) Score as a Prognosis Prediction of Spontaneous Intracerebral Hemorrhage at Rumah Sakit Islam Surabaya Jemursari

ABSTRACT


Introduction
Stroke is said to be a catastrophic disease because it has a broad impact on the economy and society. The 2018 Basic Health Research (Riskesdas) stated that the prevalence of stroke was 10.9 per mile with the highest prevalence in East Kalimantan Province (14.7 per mile) and the lowest in Papua Province (4.1 per mile). Data from the Healthcare and Social Security Agency Aulia, N. N., Syifak, S., Yuniati, D., Alam, I. P., Surya, P. A. IIMJ Volume 4 No. 2, June 2023 (1-12)  Stroke is a disease that affects the arteries leading to and within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or ruptured blood vessels which result in the brain not being able to get the oxygen and nutrients it needs so that the brain cells die (ASA, 2021).
Data from the Indonesia Stroke Registry in 2012-2013 showed 20.3% of deaths in the first 48 hours after stroke (Anindhita and Wiratman, 2014, pp. 452). Stroke is the number 1 cause of death in Indonesia (Sulistyowati, 2017). In the United States, stroke is the 5th leading cause of death and the most common cause of disability (ASA, 2021).
At least 1 in 5 cases of stroke is related to obesity, 1 in 10 cases is related to smoking, 1 in 4 cases is due to insufficient consumption of fruits and vegetables, and 1 million cases are related to excessive alcohol consumption. There are >50% of stroke cases related to high blood pressure, 1 in 4 cases is related to high LDL levels, and 9% of cases occur due to irregular heart rhythms (Sulistyowati, 2017).
A stroke can be caused by a clot that blocks the blood flow to the brain (ischemic stroke) or by a ruptured blood vessels that block the blood flow to the brain (hemorrhagic stroke) (ASA, 2021). There are 2 types of hemorrhagic stroke, namely intracerebral hemorrhage or subarachnoid hemorrhage (ASA, 2021). Hemorrhagic stroke occurs in 10-15% of stroke cases, with an incidence rate of 24.6 per hundred thousand people each year (Ziawi and Carhuapoma, 2018).
Although the data suggest that stroke has an economic burden and a high mortality rate, intracerebral hemorrhage still has no specific therapy. The financial impact of intracerebral hemorrhage that has been highlighted is that although patients have a long stay in the intensive care unit, intracerebral hemorrhage still has a high mortality after 30 days of bleeding. If the patient survives, severe disability can occur (Ziawi and Carhuapoma, 2018 Aulia, N. N., Syifak, S., Yuniati, D., Alam, I. P., Surya, P. A. IIMJ Volume 4 No. 2, June 2023 (1-12) 3 clinical settings; yet mortality during hospitalization is also required. Therefore, the intracerebral hemorrhage-grading scale score (ICH-GS score) is calculated for prediction of outcome after intracerebral hemorrhage based on evaluations performed at the time the patient came to the hospital (Sandoval et. al., 2006).   Aulia, N. N., Syifak, S., Yuniati, D., Alam, I. P., Surya, P. A. IIMJ Volume 4 No. 2, June 2023 (1-12) 5 vessels to rupture. The blood that comes out will accumulate and form a blood clot (hematoma) in the brain parenchyma. The volume of the hematoma will increase, generally within 24-48 hours of onset, causing a space compression effect that compresses the brain parenchyma and causes an increase in intracranial pressure (Anindhita and Wiratman, 2014, pp. 515-516).

Results and Discussion
The  4.5% (5 people) had an ICH-GS score of 10; 3.6% (4 people) had an ICH-GS score of 11; and 0.9% (1 patient) had an ICH-GS score of 12. The data on ICH-GS score and the outcomes of patients showed that among patients who had an ICH-GS score of 5, 5 people were found with survival outcome and 1 person was found with death outcome.
In the data regarding infratentorial bleeding with a volume <10 mL, it was found that 1 person had survival outcome and 4 people with a death outcome. In the data regarding infratentorial bleeding volume >20 mL, 1 person had survival outcome and 1 person died.  In the data concerning with the location of bleeding and outcomes, 89 patients with supratentorial hemorrhage were found with survival outcomes and 13 died, while in infratentorial bleeding, 3 patients were alive and 5 people died. should have better prognosis than the higher score), while the information based only on volume and location can predict the prognosis more consistently.