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Year : 2014  |  Volume : 4  |  Issue : 4  |  Page : 237-240

Artificial nutrition in intracerebral hemorrhage: Could clinical decision-making be supported with the application of the Essen score?

1 Department of Stroke Medicine, Conquest Hospital, The Ridge, St Leonards on Sea, East Sussex Healthcare Trust, England, United Kingdom
2 Department of Nutrition and Dietetics, Chelsea and Westminster Hospital, London, England, United Kingdom

Correspondence Address:
Dominique Wakefield
GP Registrar Conquest Hospital, The Ridge, St Leonards on Sea, East Sussex Healthcare Trust, TN37 7RD
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2231-0738.139405

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Introduction: Intracerebral Hemorrhage (ICH) accounts for 10% of all patients presenting with acute stroke in the United Kingdom (UK).The 30-day mortality from ICH ranges from 35 to 52 per cent one-half of these deaths occur within the first two days. The significant mortality associated with ICH poses a significant challenge for the clinician, particularly with regard to decision-making around the 'appropriateness' of interventions, which may not improve or support the short-term or long-term outcomes. Aim: To examine whether the Essen Score in conjunction with dysphagia assessments could aid prognostication and decision-making, particularly with regards to artificial nutritional support and end-of-life care decision-making in patients with ICH. Materials and Methods: We retrospectively reviewed the notes of 42 patients admitted to our Stroke Unit with a primary diagnosis of spontaneous ICH, between December 2011 and June 2013. Data on survival, mortality, presence of dysphagia, and the utilization of artificial nutrition were recorded. The Essen score was applied to the same cohort of patients, with subsequent comparison of the predicted and actual outcomes. Result: Sixteen patients (38%) had an Essen score >7, with an average survival of three days. Ten patients (24%) had Essen scores <3. To date the average survival in this group is 305 days. Conclusion: We would postulate that discussions with the families of ICH patients presenting with Essen scores >7 and total dysphagia, need to focus on limiting any invasive medical treatment, including the use of artificial feeding, among cases highly unlikely to benefit from it. This highlights the potential use of the Essen score as a tool in conjunction with clinical judgment, to facilitate discussions around short-term and long-term goals set for individual patients, among the multidisciplinary team, family, and carers.

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