Abstract P459: Inversion of T Waves on Admission is Associated With Mortality in Spontaneous Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Andrea Loggini ◽  
Faten El Ammar ◽  
Ruth Tangonan ◽  
Christopher L Kramer ◽  
Christos Lazaridis ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Care Center ◽  
Tertiary Care ◽  
Insular Cortex ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Qtc Prolongation ◽  
Prognostic Accuracy ◽  
Qrs Prolongation ◽  
Ich Score ◽  
T Waves

Introduction: Cardiac dysfunction directly caused by spontaneous intracerebral hemorrhage (ICH) is a poorly understood phenomenon, and its impact on outcome is still uncertain. Aim of this study is to investigate the relationship between electrocardiographic (EKG) abnormalities and mortality in ICH. Methods: This is a retrospective study analyzing EKG patterns on admission in patients admitted with ICH at a tertiary care center over eight-year period. For each patient, demographics, medical history, clinical presentation, EKG on admission and repeated during hospitalization, and head CT at presentation were reviewed. Mortality was noted. Results: A total of 301 ICHs were included in the study. The most prevalent EKG abnormalities were QTc prolongation in 56% of patients (n=168) followed by inversion of T waves (TWI) in 37% of patients (n=110). QTc prolongation was associated with ganglionic location (p=0.03) and intraventricular hemorrhage (IVH) (p=0.01), TWI was associated with ganglionic location (p=0.02), PR prolongation with IVH (p=0.01), while QRS prolongation was associated with lobar location (p<0.01). Volume of ICH, hemispheric laterality, and involvement of insular cortex were not correlated with specific EKG patterns. In a logistic regression model, after correcting for ICH severity and prior cardiac history, presence of TWI was independently associated with mortality (OR: 3.04, CI:1.6-5.8, p<0.01). Adding TWI to ICH score improved its prognostic accuracy (AUC 0.81). Disappearance of TWI during hospitalization did not translate in improvement of survival (p=0.5). Conclusion: Presence of TWI on admission is an independent and unmodifiable factor associated with mortality in ICH. TWI may be implemented as an additional early prognostic tool in clinical practice.

Abstract 68: Palliative Care Is Underutilized in Patients with Severe Intracerebral Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
April Sisson ◽  
Karen C Albright ◽  
Michelle Peck ◽  
Linh M Nguyen ◽  
Michael Lyerly ◽  
...  
Keyword(s):  
Palliative Care ◽  
Poor Prognosis ◽  
Care Service ◽  
Care Center ◽  
Symptom Relief ◽  
Tertiary Care ◽  
Palliative Care Service ◽  
Code Status ◽  
Ich Score ◽  
Expected Mortality

Background and Purpose: Palliative care is an essential part of ICH care, particularly in patients with high ICH scores given their poor prognosis. Palliative care involves consultation by the Palliative Care Service and includes de-escalation of care, changing code status, and making pain and symptom relief the central goal of management. Methods: We performed a retrospective review of consecutive patients presenting to our tertiary care center from 2008-2013 with primary ICH. Demographic and clinical data were collected. Our sample included only patients who died or were transferred to hospice. We examined the proportion of patients that received an inpatient palliative care consult and compared this group to patients who did not receive an inpatient palliative care consult. Patients were categorized by ICH score. Results: Of the 99 ICH patients who died or were discharged to hospice, only 23% received a palliative care consult. Figure 1 displays death, predicted death, and palliative care consult proportions by ICH score. Patients that received a Palliative Care consult were older (mean age 65 vs. 73, p=0.018) and more frequently had evidence of infection (32% vs. 13%, p=0.038); no other significant differences were found between groups. Conclusions: In our sample of ICH patients, 23% of patients received a palliative care consult. In those with high ICH scores utilization was only 28%, despite 30 day expected mortality of 97% or greater. This raises concern that palliative care may be underutilized in patients who may benefit from it the most.

scholarly journals Machine Learning-Based Approaches for Prediction of Patients’ Functional Outcome and Mortality after Spontaneous Intracerebral Hemorrhage

2022 ◽  
Vol 12 (1) ◽  
pp. 112
Author(s):  
Rui Guo ◽  
Renjie Zhang ◽  
Ran Liu ◽  
Yi Liu ◽  
Hao Li ◽  
...  
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Laboratory Data ◽  
Predictive Performance ◽  
High Morbidity ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Receiver Operating Characteristic Curves ◽  
Ich Score

Spontaneous intracerebral hemorrhage (SICH) has been common in China with high morbidity and mortality rates. This study aims to develop a machine learning (ML)-based predictive model for the 90-day evaluation after SICH. We retrospectively reviewed 751 patients with SICH diagnosis and analyzed clinical, radiographic, and laboratory data. A modified Rankin scale (mRS) of 0–2 was defined as a favorable functional outcome, while an mRS of 3–6 was defined as an unfavorable functional outcome. We evaluated 90-day functional outcome and mortality to develop six ML-based predictive models and compared their efficacy with a traditional risk stratification scale, the intracerebral hemorrhage (ICH) score. The predictive performance was evaluated by the areas under the receiver operating characteristic curves (AUC). A total of 553 patients (73.6%) reached the functional outcome at the 3rd month, with the 90-day mortality rate of 10.2%. Logistic regression (LR) and logistic regression CV (LRCV) showed the best predictive performance for functional outcome (AUC = 0.890 and 0.887, respectively), and category boosting presented the best predictive performance for the mortality (AUC = 0.841). Therefore, ML might be of potential assistance in the prediction of the prognosis of SICH.

scholarly journals Outcome of Primary Intracerebral Hemorrhage: A Study in Tertiary Care Center

2020 ◽  
Vol 2 (2) ◽  
pp. 35-40
Author(s):  
Jagat Narayan Rajbanshi ◽  
Pankaj Raj Nepal
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Systolic Blood Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Brain Parenchyma ◽  
Chronic Hypertension ◽  
Midline Shift ◽  
Male Predominance ◽  
The Mean

 Background: Intracerebral hemorrhage (ICH) is an irreversible phenomenon inside the brain parenchyma resulting in mild to severe neurological deficit. Based on etiology it is broadly divided into primary and secondary. Primary ICH is usually due to the rupture of Charcot-Bouchard aneurysm and chronic hypertension. Charcot – Bouchard aneurysms are supposed to get formed due to lipohyalinosis. With the aim to evaluate the outcome of primary ICH admitted to our institute this study is performed. Materials and methods: This is a prospective analytical study, where all the consecutive patients of the primary ICH were collected. Quantitative variables like age, the volume of hematoma, midline shift, GCS, and systolic blood pressure (SBP) were presented as mean and standard deviation (S.D). Whereas, qualitative variables like gender, site, and side of hematoma, type of treatment, best motor response were presented in frequency and percentage. The outcome of the patient was measured using the Glasgow outcome scale (GOS) and the association between qualitative/quantitative variables and GOS was done using the chi-square test or Fischer exact test whenever applicable in SPSS20. Results: There were a total of 31 patients with a mean age of 59.81(S. D 15.8) year and male predominance (74%). The mean volume of hematoma was 40 ml. Similarly, midline shift ranged from zero to 14 mm. The majority of primary ICH were located in basal ganglia (35%) and on the right side (52%). The mean GCS at presentation was 12.1 (S.D 2.166). Mean Systolic blood pressure was 163.77 mmHg (S.D 34.6 mmHg) with maximum SBP up to 240mmHg. There was a 14% mortality in this study group with favorable outcome (GOS 4 and 5) in 82%. GOS was significantly associated with the volume of hematoma and midline shift. Conclusion: The outcome of primary ICH is strongly associated with the volume of hematoma and midline shift. They were generally associated with hypertension with a mean systolic blood pressure of >160 mm Hg.

Abstract TP330: Insular Cortex Lesions are Associated With Early Mortality in Patients With Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Luis Prats-Sánchez ◽  
Fernando Fayos ◽  
Elba Pascual-Goñi ◽  
Celia Painous ◽  
Pol Camps-Renom ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Independent Predictor ◽  
Tertiary Care ◽  
Insular Cortex ◽  
Brain Atlas ◽  
Lesion Volume ◽  
Care Hospital ◽  
Cox Regression Analysis ◽  
Coma Scale

Introduction: Insular lesions have been described as an independent predictor of death in acute ischemic stroke. This study was undertaken to determine the influence of insular damage on the mortality of patients with intracerebral hemorrhage (ICH). Hypothesis: Insular cortex lesions are an independent predictor of death in acute ICH. Methods: This is an observational study of consecutive patients with spontaneous acute ICH who were admitted to a tertiary care hospital. The following data were collected prospectively: age, sex, traditional vascular risk factors, vital signs, CT findings (secondary intraventricular hemorrhage, hematoma volume), Glasgow Coma Scale score, time and cause of death within hospitalization. The insular cortex damage (right, left or any) was assessed by a blind evaluator using an interactive brain atlas. The association between insular lesions and mortality was investigated by use of logistic regression and Cox proportional hazards models. Results: We included 276 patients whose mean age was 77±14.3 years; 52.7% of them were men. During a median of 7 days (interquartile range 2-15) of hospitalization, 91 (32.9%) deaths were recorded. We observed 72 (26%) patients with insular cortex lesions (right insula=34, left insula=38). Cox regression analysis showed that age (adjusted hazard ratio [aHR] 1.02, 95% CI 1.00-1.04; p<0.001), Glasgow Coma Scale (aHR 0.84, 95% CI 0.80-0.89; p<0.001), lesion volume (aHR 1.10, 95% CI 1.06-1.15; p<0.001) and any insular damage (aHR 2.19, 95% CI 1.40-3.42, p=0.002) were significant predictors of death within hospitalization. Conclusions: In conclusion, insular cortex lesions adversely influence survival after spontaneous ICH. This finding was observed even after adjustment for other well-known predictors of ICH mortality.

Abstract 3229: Criteria for Appropriate Utilization of Helicopter Interfacility Transfer of ICH Patients

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Dustin J Calhoun ◽  
Shana Bogenschneider ◽  
Phaniraj Iyengar ◽  
Andrew W Asimos
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
High Sensitivity ◽  
Brainstem Compression ◽  
Tertiary Center ◽  
Ich Score ◽  
Gcs Score ◽  
To Receive ◽  
Neurosurgical Intervention

Background: Many intracranial hemorrhage (ICH) patients are emergently transferred to tertiary neurosurgical centers by helicopter emergency medical services (HEMS), yet no guidelines exist for HEMS use in acute ICH. The American Stroke Association (ASA) publishes guidelines for neurosurgical intervention in ICH patients. Additionally, high ICH scores have been shown to predict lethal ICHs. We hypothesized that an algorithm including ASA guideline criteria and ICH score would identify patients for whom HEMS transportation might be appropriate. Objectives: To determine, in ICH patients transferred by HEMS, (1) the sensitivity of ASA guidelines for predicting emergent neurosurgical intervention, and (2) the ability of an ICH score ≥4 to predict early mortality and failure to receive intervention. Methods: We conducted a retrospective chart review of ICH patients transported by HEMS to one tertiary care center between September 2008 and February 2011. We reviewed medical records and brain CTs from the hospital of first presentation to calculate ICH scores and to evaluate for the seven ASA guideline criteria: GCS score ≤8, herniation, intraventricular hemorrhage, hydrocephalus, brainstem compression, lobar clot >30 mL within 1 cm of the paranchymal surface, and cerebellar hemorrhage. We reviewed tertiary center records for neurosurgical interventions and in-hospital mortality. Results: Review of 137 patient records identified 86 patients with an ICH and an available initial brain CT. All patients who received an emergent intervention met at least one of the criteria (sensitivity 100%), while 16 (18.6%) patients transferred by HEMS met no ASA criteria. No patient with an ICH score of ≥4 (n=19) received an emergent neurosurgical intervention, and only one such patient survived to hospital discharge. Comparison of this group to all others produced a hazard ratio of 5.86. Thirty-five (40.7%) patients had either no ASA criteria or an ICH score ≥4. Conclusions: The ASA guidelines have high sensitivity for detecting those patients who will receive emergent neurosurgical intervention after transfer, while patients with ICH scores of ≥4 almost uniformly have lethal hemorrhages and do not undergo emergent intervention. An algorithm including the presence of at least one of the seven ASA ICH neurosurgical intervention criteria and an ICH score <4 can be used to screen for appropriate use of HEMS transport in acute ICH.

scholarly journals Determining ICH Score: can we go beyond?

2009 ◽  
Vol 67 (3a) ◽  
pp. 605-608 ◽  
Author(s):  
Gustavo Cartaxo Patriota ◽  
João Manoel da Silva-Júnior ◽  
Alécio Cristino Evangelista Santos Barcellos ◽  
Joaquim Barbosa de Sousa Silva Júnior ◽  
Diogo Oliveira Toledo ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Auxiliary Variable ◽  
Accurate Information ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Great Heterogeneity ◽  
One Year ◽  
The One ◽  
Ich Score ◽  
Reliable Scale

Spontaneous intracerebral hemorrhage (SICH) still presents a great heterogeneity in its clinical evaluation, demonstrating differences in the enrollment criteria used for the study of intracerebral hemorrhage (ICH) treatment. The aim of the current study was to assess the ICH Score, a simple and reliable scale, determining the 30-day mortality and the one-year functional outcome. Consecutive patients admitted with acute SICH were prospectively included in the study. ICH Scores ranged from 0 to 4, and each increase in the ICH Score was associated with an increase in the 30-day mortality and with a progressive decrease in good functional outcome rates. However, the occurrence of a pyramidal pathway injury was better related to worse functional outcome than the ICH Score. The ICH Score is a good predictor of 30-day mortality and functional outcome, confirming its validity in a different socioeconomic populations. The association of the pyramidal pathway injury as an auxiliary variable provides more accurate information about the prognostic evolution.

scholarly journals Prognostication after intracerebral hemorrhage: a review

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Jens Witsch ◽  
Bob Siegerink ◽  
Christian H. Nolte ◽  
Maximilian Sprügel ◽  
Thorsten Steiner ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Intracerebral Hemorrhage ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Prognostic Scores ◽  
Predictor Variables ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Net Benefit ◽  
Patient Reported ◽  
Ich Score

Abstract Background Approximately half of patients with spontaneous intracerebral hemorrhage (ICH) die within 1 year. Prognostication in this context is of great importance, to guide goals of care discussions, clinical decision-making, and risk stratification. However, available prognostic scores are hardly used in clinical practice. The purpose of this review article is to identify existing outcome prediction scores for spontaneous intracerebral hemorrhage (ICH) discuss their shortcomings, and to suggest how to create and validate more useful scores. Main text Through a literature review this article identifies existing ICH outcome prediction models. Using the Essen-ICH-score as an example, we demonstrate a complete score validation including discrimination, calibration and net benefit calculations. Score performance is illustrated in the Erlangen UKER-ICH-cohort (NCT03183167). We identified 19 prediction scores, half of which used mortality as endpoint, the remainder used disability, typically the dichotomized modified Rankin score assessed at variable time points after the index ICH. Complete score validation by our criteria was only available for the max-ICH score. Our validation of the Essen-ICH-score regarding prediction of unfavorable outcome showed good discrimination (area under the curve 0.87), fair calibration (calibration intercept 1.0, slope 0.84), and an overall net benefit of using the score as a decision tool. We discuss methodological pitfalls of prediction scores, e.g. the withdrawal of care (WOC) bias, physiological predictor variables that are often neglected by authors of clinical scores, and incomplete score validation. Future scores need to integrate new predictor variables, patient-reported outcome measures, and reduce the WOC bias. Validation needs to be standardized and thorough. Lastly, we discuss the integration of current ICH scoring systems in clinical practice with the awareness of their shortcomings. Conclusion Presently available prognostic scores for ICH do not fulfill essential quality standards. Novel prognostic scores need to be developed to inform the design of research studies and improve clinical care in patients with ICH.

scholarly journals Factors predicting pneumonia in patients admitted with spontaneous supratentorial intracerebral hemorrhage in western region of Nepal

2021 ◽  
Vol 2 (1) ◽  
pp. 31-36
Author(s):  
Subhash Yogi ◽  
Joshan Neupane ◽  
Aabishkar Bhattarai ◽  
Bijaya Karki ◽  
Benju Tilija Pun
Keyword(s):  
Diabetes Mellitus ◽  
Intracerebral Hemorrhage ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Chi Square ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Medical College ◽  
Increased Risk ◽  
Student’S T ◽  
Ich Score

Introduction: Despite the well-documented association of stroke-associated complications and infections with increased mortality, morbidity and worse long-term outcome, there are only limited data available on independent predictors of pneumonia in patients with acute intracerebral hemorrhage. In this study, our objective was to evaluate risk factors and comorbid conditions associated with the diagnosis of hospital acquired pneumonia in the patients admitted with spontaneous intracerebral hemorrhage and to determine the independent predictors of pneumonia in these patients. Methods: A retrospective analysis was done in patients admitted in Intensive Care Unit of Nepalgunj Medical College with spontaneous intracerebral hemorrhage. Various clinic-demographic parameters were tested for association with pneumonia or no pneumonia group using chi square or student’s “t” test. Results: A total of 117 patients, 86 men (73.5%) and 31 women (26.5%) with spontaneous intracerebral hemorrhage were included in the study. There were 36 (30.77%) patients with pneumonia. The association Diabetes mellitus (p<0.01), COPD (p<0.01), smoking (p<0.01), mean GCS (p<0.01), ICH volume (p=0.01), ICH score (p<0.01), operated status (p<0.01), Ganglionic (<0.01), Brain stem (p=0.03) and Ventricular (p=0.01) location of hematoma was statistically significant with pneumonia. Outcome in terms of MRS at discharge was also poorer for patients with pneumonia (p=0.01). Conclusion: Diabetes mellitus, COPD, mean GCS, ICH volume, ICH score, operated status, higher MRS score were associated with increased risk of pneumonia in ICH. Similarly, ganglionic hematoma, brainstem hematoma and those having intraventricular hemorrhages are also associated with increased risk of pneumonia. Outcome in patients in terms of MRS were also poorer in those who had pneumonia.

Abstract 148: Evaluation of Sex, Racial and Geographic Demographics and Outcomes in Clinical Trials of Spontaneous Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lauren Koffman ◽  
Daniel Hanley ◽  
Craig Anderson ◽  
David Mendelow ◽  
Barbara Gregson ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Intracerebral Hemorrhage ◽  
Disease Process ◽  
Geographic Location ◽  
Pooled Analysis ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Representation Of Women ◽  
Artery Disease ◽  
Poor Outcomes ◽  
Ich Score

Introduction: As large clinical trials for spontaneous intracerebral hemorrhage (ICH) increasingly influence management, recruitment of diverse populations must be ensured to fully understand the disease process and benefit of interventions to the general public. There is little data on sex, race and outcomes in ICH trials. We hypothesize that women and geographic minorities are underrepresented in ICH clinical trials and that there exist population specific differences in mortality, functional outcomes and response to interventions. Methods: Pooled analysis of 5456 subjects from the following clinical trials: VISTA (985), INTERACT I (404) and II (2829), STICH II (597), MISTIE II (141) and CLEAR III (500). Patients were grouped by sex, race, and geographic location. Modified Rankin Scale [mRS] was obtained at 30 days and 3 months. Results: More men than women participated in ICH trials (61.9% vs. 38.1%); women were older and more likely to have hypertension; men had more coronary artery disease. Women presented with lower Glasgow Coma scale, higher ICH score and more intraventricular hemorrhage. Day 90 mortality was 13.9% in women and 16.6 % in men (p=0.01); 90 day poor outcome (mRS 3-5) was 57.2% in women and 51.0% in men (p<0.001). Only mortality was significantly different between sexes after adjustment for ICH score. Race representation varied in these clinical trials: 1.5% Hispanic; 6.6% black; 14% Arabic; 31% white and 43.4% Asian. Day 90 mortality and mRS 3-5 were highest in Hispanics (22.1%, 78.3%, respectively) and lowest in Asians (9.5%, 43.8%). Hispanics had higher ICH score, but blacks and Hispanics had lower day 90 mortality compared to whites in adjusted models. Asians had both lower mortality and less day 90 mRS 3-5 vs. whites while Arabics and blacks were more likely to have day 90 mRS 3-5. Study interventions were well balanced by sex and race. Conclusions: Sex and race representation in ICH clinical trials only partially equate to current understanding of epidemiology of ICH. There is a lack of trial evidence from Africa and South America and under-representation of women, Hispanics and blacks. Despite higher ICH severity, Hispanics had lower adjusted mortality risk while males had higher risk and Arabics and blacks had worse adjusted poor outcomes.

Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage

2019 ◽  
Vol 15 (1) ◽  
pp. 90-102 ◽  
Author(s):  
Natasha Ironside ◽  
Ching-Jen Chen ◽  
Victoria Dreyer ◽  
Brandon Christophe ◽  
Thomas J Buell ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Dependence ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
Independent Effect ◽  
Study Cohort ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume ◽  
Multivariable Regression ◽  
Ich Score

Background and objective Functional outcome after spontaneous intracerebral hemorrhage (ICH) may vary depending on hematoma volume and location. We assessed the interaction between hematoma volume and location, and modified the original ICH score to include such an interaction. Methods Consecutive ICH patients were enrolled in the Intracerebral Hemorrhage Outcomes Project from 2009 to 2017. Inclusion criteria were age≥18 years, baseline modified Rankin Scale (mRS) score 0–2, neuroimaging, and follow-up. Functional dependence and mortality were defined as 90-day mRS>2 and death, respectively. A location ICH score was developed using multivariable regression and area under the receiver operator characteristic curve (AUROC) analyses. Results The study cohort comprised 311 patients, and the derivation and validation cohorts comprised 209 and 102 patients, respectively. Interactions between hematoma volume and location predicted functional dependence ( p = 0.008) and mortality ( p = 0.025). The location ICH score comprised age≥80 years (1 point), Glasgow Coma Scale score (3–9 = 2 points; 10–13 = 1 point), volume–location (lobar:≥24 mL=2 points, 21–24 mL=1 point; deep:≥8 mL=2 points, 7–8 mL=1 point; brainstem:≥6 mL=2 points, 3–6 mL=1 point; cerebellum:≥24 mL=2 points, 12–24 mL=1 point), and intraventricular hemorrhage (1 point). AUROC of the location ICH score was higher in functional dependence (0.883 vs. 0.770, p = 0.002) but not mortality (0.838 vs. 0.841, p = 0.918) discrimination compared to the original ICH score. Conclusions The interaction between hematoma volume and location exerted an independent effect on outcomes. Excellent discrimination of functional dependence and mortality was observed with incorporation of location-specific volume thresholds into a prediction model. Therefore, the volume–location relationship plays an important role in ICH outcome prediction.

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