ONLINE SUPPLMENT
Intracerebral Hemorrhage Location and Functional Outcomes of Patients: A Systematic Literature Review and Meta-Analysis
Table I. List of terms used in search of OVID MEDLINE Database (1946-2015) conducted on August 7, 2015.
MeSH Terms Search[Group Term]
Intracranial Hemorrhage, Hypertensive/
Intracranial Hemorrhage, Traumatic/
cerebral hemorrhage.mp.
[Outcome Term]
exp Prognosis/
exp "Outcome Assessment (Health Care)"/
exp Survival Analysis/
exp "Quality of Life"/
exp "Activities of Daily Living"/
adl*.mp.
outcome*.mp.
exp Cognition Disorders/
[Languages]
English
[Ages]
Adult: 19+
[Article type]
Clinical trial, all
Comparative Study
Controlled Clinical Trial
Journal Article; Meta Analysis
Multicenter study
Observational study
Randomized Controlled Trial
Review
Systematic Reviews
Unindexed Article Search
[Group Term]
Cerebral hemorrhage*
Intracranial hemorrhage*
Intracerebral hemorrhage*
[Outcome Term]
prognosis
outcome*
ADL*
"activities of daily living"
"quality of life"
cognition
[Unindexed Search]
publisher [sb]
inprocess[sb]
pubmednotmedline[sb]
pubstatusaheadofprint)
[Languages]
English
[Ages]
Adult: 19+
[Article type]
Clinical trial, all
Comparative Study
Controlled Clinical Trial
Journal Article; Meta Analysis
Multicenter study
Observational study
Randomized Controlled Trial
Review
Systematic Reviews
Table II. Information abstracted from individual studies in the final literature review.
Information Extracted from StudiesPublication Year
First Author
Main Study Objectives
Country of Enrollment
Study Design
Total Sample Size
Total Subjects with Location Analysis*
Location Names
Number per Location
Information Regarding Location Designation (Including introduction of biases)
Follow-up Time
Subjects Alive by Endpoint*
Subjects Dead by Endpoint*
Percent Mortality*
Outcome Measures
Measure Cutoffs
Domains of Measure
Type of Statistical Analysis Conducted
Statistics and P-Value Provided by Article
Conclusion/Interpretation*
*Extrapolated when information was not directly provided within article
Table III. Study design of 37 studies within the review.
Ref # / Year / Country / Sample Size (n) / Purpose / Mean Age / Follow-up Time / Statistical Analysis1 / 1983 / Switzerland / 108 / Factors affecting prognosis of ICH / 59 / 1 Month / Univariate
2 / 1983 / Japan / 29 / Factors affecting prognosis of ICH / 61.7 / 6 Months / Univariate
3 / 1991 / France / 166 / Factors affecting prognosis of ICH / 61 / 6 Months / Multivariate
4 / 1995 / Finland / 156 / Factors affecting prognosis of ICH / 49.6* / 12 Months / Multivariate
5 / 1999 / Sweden / 203 / Factors affecting prognosis of ICH / 42 / 6 Months / Multivariate
6 / 1999 / Japan / 37 / Outcomes of surgical operated patients / 75 / 32.5 Days§ / Univariate
7 / 1999 / China / 32 / ICH in chronic kidney disease patients / 56.5 / 6 Months / Univariate
8 / 2000 / Korea / 94 / Effect of rehab on prognosis / 59.6 / 106 Days§ / Univariate
9 / 2000 / Taiwan / 22 / Prognosis ischemic stroke vs. ICH / 56.7 / 51.7 Days§ / Univariate
10 / 2002 / Spain / 185 / Factors affecting prognosis of ICH / 65 / 6 Months / Multivariate
11 / 2003 / Hong Kong / 141 / Validation of prediction scores / 69.3 / 1 Month / Univariate
12 / 2005 / Spain / 138 / Factors affecting prognosis of ICH / 70 / 3 Months / Univariate/Multivariate
13 / 2008 / USA / 629 / Validation of prediction scores / 70 - 79† / 3 Months / Multivariate
14 / 2009 / 22 Countries / 621 / Quality of life of ICH patients / 64 / 3 Months / Multivariate
15 / 2009 / 22 Countries / 596 / Depression in ICH patients / 63 / 3 Months / Multivariate
16 / 2009 / Korea / 585 / Factors affecting prognosis of ICH / 63 / 3 Months / Univariate/Multivariate
17 / 2010 / Malaysia / 60 / Investigating imaging techniques / 56.7 / 3 Months / Univariate
18 / 2011 / Malaysia / 60 / Investigating imaging techniques / 56.7 / 6 Months / Multivariate
19 / 2011 / China / 90 / Investigating imaging techniques / 56 / 3 Months / Univariate
20 / 2012 / Japan / 30 / Outcomes of surgical operated patients / 70* / 1 Month / Univariate
21 / 2012 / Japan / 211 / Blood pressure management / 65.6 / 3 Months / Multivariate
22 / 2012 / Japan / 23 / Investigating imaging techniques / 65 / 3 Months / Univariate
23 / 2012 / Japan / 460 / Factors affecting prognosis of ICH / 62 / 12 Months / Univariate/Multivariate
24 / 2013 / USA / 323 / Blood pressure management / 74 / 3 Months / Multivariate
25 / 2013 / France / 60 / Cognition in ICH patients / 61.7 / 40 Months§ / Univariate
26 / 2013 / China / 3,255 / Validation of prediction scores / 62* / 12 Months / Multivariate
27 / 2013 / Korea / 32 / ICH in chronic kidney disease patients / 62 / 42 Days§ / Univariate
28 / 2013 / Japan / 211 / Blood pressure management / 65* / 3 Months / Univariate
29 / 2013 / Taiwan / 47 / Investigating imaging techniques / 65.5 / 6 Months / Univariate/Multivariate
30 / 2014 / China / 252 / Predictive value of biomarkers / 58 / 3 Months / Multivariate
31 / 2014 / Korea / 47 / Outcomes of surgical operated patients / 57 / 3 Months / Univariate
32 / 2014 / Finland / 807 / Predictive value of biomarkers / 69 / 3 Months / Multivariate
33 / 2014 / China / 25 / Investigating imaging techniques / 54 / 3 Months / Multivariate
34 / 2014 / USA / 32 / Investigating imaging techniques/scores / 65.6 / 221.5 Days| | / Univariate
35 / 2014 / Norway / 83 / Cognition in ICH patients / 67.3 / 3.8 Years| | / Univariate/Multivariate
36 / 2015 / USA / 73 / Outcomes of surgical operated patients / 52 / 3 Months / Multivariate
37 / 2015 / UK / 128 / Factors affecting prognosis of ICH / 79 / 76‡ / 12 Months / Univariate
*Median age provided.
†Exact mean not provided in study.
‡Median age of lobar and non-lobar patients.
§Mean follow-up time.
| |Median follow-up time.
Table IV. Location designations and conclusions of 37 studies within the review.
Ref # / Total Sample Size (n) / Location Designations (n); Laterality Designation (n) / Methodological Considerations / Follow-up Time / Outcome Measures / Conclusions1 / 108 / Lobar (46), Ganglio-thalamus (28), Lenticular (17), Thalamus (15), Infratentorial (2) / 1 Month / ADLs / Ganglio-thalamus associated with worse outcomes than all other locations (NP, p < 0.02).
2 / 29 / Lateral Nuclei (22), All Thalamic Nuclei (7) / 6 Months / Ability in Daily Life / Better recovery for lateral nuclei compared to all thalamic nuclei (NP, p < 0.025).
3 / 166 / Lobar (30), Putamen (79), Thalamus (57); Left-sided (83), Right-sided (83) / 6 Months / GOS / No difference in outcome between locations (Putamen vs. lobar: OR 1.3, CI: 0.3-5.4, p = 0.68; Thalamus vs. lobar: OR 1.5, CI: 0.5-4.1, p = 0.44). No difference in outcome by side (OR 1.5, CI: 0.5-4.1, p = 0.44).
4 / 156 / Subcortical (34), Putamen (57), Caudate (5), Thalamus (9), Cerebellum (13), Pons (7), Pons/Caudate (31) / Systemic definitions of location provided. / 12 Months / GOS / Subcortical associated with better outcomes (OR 0.04, CI:0.01-0.27, p = 0.001). Cerebellar associated with better outcomes (OR 0.13, CI:0.02-0.95, p = 0.04).
6 / 37 / Parietal Lobe (11), Frontal Lobe (9), Occipital Lobe (11), Temporal Lobe (6) / Systemic definitions of location provided. / Mean 32.5 Days / GOS / Outcome significantly varied by location (NP, p = 0.01). No follow-up stats conducted.
7 / 32 / Lobar (9), Putamen (11), Thalamus (7), Brainstem (5) / 6 Months / ADLs / No difference in outcome by location (NP, p > 0.05).
8 / 94 / Internal Capsule/Putamen (55), Thalamus (24), Both Regions (15) / Mean 106 Days / FIM / Thalamus associated with worse gains in mobility compared to all three regions (NP, p < 0.05).
9 / 22 / Left Lobar (11), Right Lobar (11) / Location abstracted from medical review. / Mean 51.7 Days / RPAB / Right hemorrhagic strokes associated with worse scores on Figure-Ground Discrimination subtest compared to left-sided (F 7.58, p = 0.009).
10 / 183 / Lobar (88), Deep (95); Left-sided (102), Right-sided(83) / Systemic definitions of location provided. / 6 Months / mRS / Lobar associated with better functional outcomes (OR 8.60, CI: 2.73-27.10, p = 0.0002). No difference in outcome by side (Chi 3.6 X 10-4, p = 0.11).
11 / 141 / Lobar (19), Basal Ganglia (68), Thalamus (33), Cerebellum (1), Pons (8); Left-sided (63), Right-sided (78) / 1 Month / mRS / No difference in outcome by location (NP, p = 0.613). No difference in outcome by side (NP, p = 0.417).
12 / 138 / Lobar (38), Deep (100) / Study neurologists were blinded. / 3 Months / mRS / Deep associated with worse outcomes (NP, p = 0.009). Cortical associated with better outcomes (OR 3.79, CI: 1.19-12.01, p = NP).
13 / 629 / Lobar (261), Deep (294), Infratentorial (74) / Study neurologists were blinded. / 3 Months / GOS / Lobar associated with functional independence (OR 6.7, CI: 2.3-19.3, p < 0.0001).
14 / 584 / Lobar (62), Deep (497), Cerebellum (9), Brainstem (16) / 3 Months / EQ-5D / Non-lobar associated with poorer quality of life (OR 3.05, CI: 1.42-6.53, p = 0.003).
15 / 546 / Lobar (62), Deep (475), Infratentorial (9) / 3 Months / HDRS / No difference in outcome by location (OR 0.96, CI: 0.51-1.81, p = NP).
16 / 585 / Lobar (106), Basal Ganglia (323), Thalamus (156); Left-sided (287), Right-sided (293), Central (5) / 3 Months / mRS / Lobar associated with functional recovery (OR 2.65, CI: 1.40-5.03, p = 0.003); Left-sided associated with functional recovery compared to right-sided (NP, p = 0.034).
17 / 60 / Lobar (7), Basal Ganglia (53); Left-sided (28), Right-sided (32) / 3 Months / mRS / Lobar associated with better outcomes (OR 0.086, CI: 0.01-0.77, p = 0.009). No difference in outcome by side (OR 0.604, CI: 0.21-1.71, p = 0.342).
18 / 60 / Lobar (7), Basal Ganglia (53) / Systemic definitions of location provided. / 6 Months / mRS / No difference in outcome by location (OR 0.254, CI:0.028-2.263, p = 0.191). No difference in outcome by side (OR 1.235, CI:0.431-3.538, p = 0.694).
19 / 48 / Lobar (9), Deep (39) / Systemic definitions of location provided. Study neurologists were blinded. / 3 Months / mRS / No difference in outcome by location (NP, p = 0.92).
20 / 30 / Putamen (15), Thalamus (15) / 1 Month / MMT / No difference in outcome by location (NP, p = 0.833).
21 / 211 / Subcortex (12), Putamen (112), Caudate (1), Internal Capsule (1), Thalamus (75), Multiple Locations (10) / 3 Months / mRS / No difference in outcome by location (Putamen vs. non-putamen: OR 0.61, CI: 0.35-1.07, p = 0.083).
22 / 23 / Putamen (19), Thalamus (4) / 3 Months / NIHSS / No difference in outcome by location (NP, p = 1).
23 / 460 / Lobar (78), Basal Ganglia (283), Cerebellum (36), Brainstem (63) / 12 Months / mRS / Lobar had significantly worse outcomes (NP, p = 0.021).
24 / 323 / Lobar (188), Deep (135) / Systemic definitions of location provided. Study neurologists were blinded. / 3 Months / mRS / Lobar not associated with outcomes (OR 0.76, CI: 0.40-1.45, p = 0.4).
25 / 60 / Lobar (19), Deep (34), Infratentorial (7) / Study neurologists were blinded. Interobserver agreement for location selection provided. / Mean 40 Months / Clinical Exam / No difference in outcome by location (NP, p = 0.7).
26 / 3,255 / Supratentorial (2862), Infratentorial (393) / Study neurologists were blinded. / 12 Months / mRS / Infratentorial associated with worse outcome (OR 2.02, CI: 1.55-2.65, p < 0.001).
27 / 32 / Subcortical (5), Putamen (14), Caudate (1), Thalamus (5), Cerebellum (3), Pons (4) / Mean 42 Days / mRS / No difference in outcome by location (NP, p = 0.192).
28 / 211 / Lobar (14), Putamen (121), Thalamus (76) / 3 Months / mRS / No difference in outcome by location (NP, p = 0.125).
29 / 47 / Lobar (6), Basal Ganglia (12), Putamen (10), Thalamus (18), Cerebellum (1) / 6 Months / mRS / Thalamus associated with poor outcomes (OR 15.637, CI: 1.40-174.57, p = 0.026).
30 / 252 / Lobar (54), Deep (160), Infratentorial (38) / Study neurologists were blinded. / 3 Months / mRS / Deep associated with poor functional outcomes (OR 35.64, CI: 1.94-655.18, p = 0.016). Infratentorial associated with poor outcomes (OR 28.94, CI: 1.60-522.78, p = 0.023).
31 / 47 / Lobar (3), Deep (44); Left-sided (31), Right-sided (16) / 3 Months / GOS / No difference in outcome by location (NP, p = 0.364). No difference in outcome by side (NP, p = 0.754).
32 / 807 / Subcortical (237), Non-Subcortical (570) / Study neurologists were blinded. / 3 Months / GOS / Subcortical associated with better outcomes (OR 0.33, CI: 0.20-0.54, p < 0.001).
33 / 25 / Left Basal Ganglia (12), Right Basal Ganglia (13) / 3 Months / NIHSS / No difference in outcome by side (NP, p = 0.999).
34 / 32 / Lobar (22), Basal Ganglia (6), Thalamus (2), Basal Ganglia/Thalamus (2) / Study neurologists were blinded. / Median 221.5 Days / mRS / No difference in outcome by location (NP, p = 0.846).
35 / 83 / Lobar (30), Deep (37), Cerebellum (8), Brainstem (8) / Systemic definitions of location provided. / Median 3.8 Years / MoCA / Lobar associated with cognitive impairment (OR 14.1, p = 0.016).
36 / 73 / Lobar (30), Basal Ganglia (36), Both Regions (7); Left-sided (25), Right-sided (48) / 3 Months / GOS / No analysis by location. Left-sided associated with worse outcomes compared to right-sided (Z -2.48, p = 0.013).
37 / 128 / Lobar (68), Non-Lobar (60) / Systemic definitions of location provided. / 12 Months / mRS / No difference in outcome by location (Chi 0.3, p = 0.58).
5 / 203 / Lobar (97), Basal Ganglia (106); Left-sided (95), Right-sided (108) / 6 Months / mRS / Basal ganglia associated with worse outcomes (Chi 18.2, p < 0.0001). No difference in outcome by side (NP, p = NP).
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