Kadek Dinda Pramadyanti, Putu Cahya Budi Utama, Komang Wiswa Mitra Kenwa, Putu Nanda Pramadya

Hubungan volume pendarahan intracerebral pada hasil CT-Scan kepala dengan tingkat kesadaran pada pasien stroke saat pertama kali datang ke IGD Rumah Sakit Umum Daerah Kabupaten Klungkung pada bulan Oktober 2023 sampai Februari 2024

Introduction

Hubungan volume pendarahan intracerebral pada hasil ct-scan kepala dengan tingkat kesadaran pada pasien stroke saat pertama kali datang ke igd rumah sakit umum daerah kabupaten klungkung pada bulan oktober 2023 sampai februari 2024. Penelitian ini mengkaji hubungan volume perdarahan intraserebral dengan tingkat kesadaran (GCS) pada pasien stroke di IGD RSUD Klungkung. CT scan penting sebagai prediktor risiko koma.

Abstract

Background: Hemorrhagic stroke is one of the leading causes of morbidity and mortality. A CT scan plays a vital role in the diagnosis and management of this condition. This study aims to assess the relationship between intracerebral hemorrhage volume and level of consciousness in stroke patients. Methods: A retrospective analytical study with a cohort approach was conducted using medical record data of intracerebral hemorrhage patients at RSUD Kabupaten Klungkung from October 2023 until February 2024. The volume of hemorrhage was calculated using the ABC/2 method and categorized into minor hemorrhage (<30 ml) and major hemorrhage (≥30 ml). The level of consciousness was assessed using the Glasgow Coma Scale (GCS) and grouped into non-coma (9-15) and coma (3-8). Statistical analysis included the chi-square test and logistic regression. Results: Of the 30 patients, 70% had minor hemorrhage and 30% had major hemorrhage. There was a significant negative correlation between the volume of hemorrhage and the total GCS score (r=-0.522, p=0.003). Patients with large hemorrhage volumes had a 12-fold higher risk of coma compared to minor hemorrhages (OR=12.0, 95% CI: 1.89-76.15, p=0.008). Multivariate analysis showed major hemorrhage volume as an independent predictor of coma risk (adjusted OR=8.5, 95% CI: 1.5-48.2, p=0.015). Conclusion: There is a significant relationship between intracerebral hemorrhage volume and coma risk in stroke patients. CT scan plays a vital role in the accurate evaluation of hemorrhage volume, which is a strong predictor of coma risk. These findings emphasize the importance of using CT scans in the management of hemorrhagic stroke patients. Latar Belakang: Stroke hemoragik merupakan penyebab signifikan morbiditas dan mortalitas. CT scan berperan penting dalam diagnosis dan manajemen kondisi ini. Penelitian ini bertujuan menilai hubungan antara volume perdarahan intraserebral dengan tingkat kesadaran pada pasien stroke. Metode: Studi analitik retrospektif dengan pendekatan kohort dilakukan menggunakan data rekam medis pasien perdarahan intraserebral di RSUD Kabupaten Klungkung dari Oktober 2023 hingga Februari 2024. Volume perdarahan dihitung menggunakan metode ABC/2 dan dikategorikan menjadi kecil (<30 ml) dan besar (≥30 ml). Tingkat kesadaran dinilai menggunakan Glasgow Coma Scale (GCS) dan dikelompokkan menjadi tidak koma (9-15) dan koma (3-8). Analisis statistik meliputi uji chi-square dan regresi logistik. Hasil: Dari 30 pasien, 70% mengalami perdarahan kecil dan 30% perdarahan besar. Terdapat korelasi negatif signifikan antara volume perdarahan dan skor GCS total (r=-0.522, p=0.003). Pasien dengan volume perdarahan besar memiliki risiko 12 kali lebih tinggi mengalami koma dibandingkan perdarahan kecil (OR=12.0, 95% CI: 1.89-76.15, p=0.008). Analisis multivariat menunjukkan volume perdarahan besar sebagai prediktor independen risiko koma (adjusted OR=8.5, 95% CI: 1.5-48.2, p=0.015). Kesimpulan: Terdapat hubungan signifikan antara volume perdarahan intraserebral dan risiko koma pada pasien stroke. CT scan berperan penting dalam evaluasi akurat volume perdarahan, yang merupakan prediktor kuat risiko koma. Temuan ini menekankan pentingnya penggunaan CT scan dalam manajemen pasien stroke hemoragik.

Review

This study meticulously investigates the critical relationship between intracerebral hemorrhage volume, as determined by head CT scans, and the level of consciousness in stroke patients upon their arrival at the emergency department. Given the significant morbidity and mortality associated with hemorrhagic stroke, understanding factors that predict patient outcomes, such as consciousness level, is highly relevant for timely diagnosis and management. The authors utilized a clear retrospective analytical approach, employing standard clinical tools like the ABC/2 method for hemorrhage volume estimation and the Glasgow Coma Scale (GCS) for consciousness assessment, followed by appropriate statistical analyses including chi-square and logistic regression. The methodology is well-articulated, and the findings are presented concisely within the abstract. The findings from this research provide compelling evidence that a larger volume of intracerebral hemorrhage is a strong predictor of a reduced level of consciousness. Specifically, the study identified a significant negative correlation between hemorrhage volume and total GCS score (r=-0.522, p=0.003), and patients with major hemorrhages (≥30 ml) faced a 12-fold higher risk of coma compared to those with minor hemorrhages. Importantly, multivariate analysis confirmed major hemorrhage volume as an independent predictor of coma risk, emphasizing its prognostic value. These results underscore the critical importance of early and accurate CT scan evaluation in the management of hemorrhagic stroke patients, as the precise measurement of hemorrhage volume can significantly aid clinicians in predicting a patient's consciousness level and potentially guiding immediate therapeutic interventions. While the study offers valuable insights into the association between hemorrhage volume and consciousness, certain limitations warrant consideration. The retrospective, single-center design, coupled with a relatively small sample size (N=30) and a short observation period (October 2023 - February 2024), may limit the generalizability of these findings. Future research would greatly benefit from larger, multi-center prospective studies to validate these associations across broader populations and potentially explore other contributing factors such as hemorrhage location, patient comorbidities, and the time from symptom onset to imaging. Despite these limitations, this study provides important preliminary data affirming the role of CT scans in comprehensively assessing intracerebral hemorrhage volume as a robust early predictor of coma risk in stroke patients.

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