Brain bleed checklist offers improved treatment hope for stroke victims

Edinburgh researchers have identified four main factors that put patients at risk of a brain bleed, in one of the largest studies of its kind. The researchers focused specifically on a type of brain bleed known as intracerebral haemorrhage growth, when the volume of the bleed continues to increase after diagnosis.

 

The international team of scientists, led by the University of Edinburgh, sifted through 4.191 studies spanning over 45 years to retrieve records of patients who had experienced a brain bleed and for whom brain scanning data had been collected. The screening process yielded 36 studies covering 5.435 patients who had experienced intracerebral haemorrhage between 1985 and 2015. The study, published in the medical journal Lancet Neurology, highlights that a shorter time from patients showing signs of a brain bleed to medical investigations using brain scan led to better outcomes.

The initial volume of the bleed, and whether or not the patient was taking medication, such as aspirin or warfarin, to thin their blood or prevent clotting, were factors associated with an increased risk of the patient bleeding further.

 

Better predictions with four simple measures
Experts say the checks can be applied during routine care to help medical staff decide the best way to continue monitoring each patient.

Professor Rustam Al-Shahi Salman, of the university’s Centre for Clinical Brain Sciences, said: “We have found that four simple measures help doctors to make accurate predictions about the risk of a brain haemorrhage growing. These can be used anywhere in the world. Better prediction can help us identify which patients might benefit from close monitoring and treatment. We hope that an app could help doctors to do this.”

The four factors are simple to collect and can be included in a prediction model, or checklist to confidently inform healthcare teams about a patient’s risk of further bleed, and therefore best management options.

A fifth factor, known as ‘spot sign’, a small leakage observed during CT angiography, was also a factor alerting on risk of further bleed growth, but only marginally improved the prediction model.

 

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Source: The University of Edinburgh | 15 August 2018

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