Analysis of Symptom Clusters for Adult Patients with Hematologic Malignancies Suffering From Intracranial Hemorrhage

Purpose:
The purpose of this study is to identify early symptoms commonly suffered by the adult hematologic malignancy inpatients who manifested an intracranial hemorrhage and then to create a communication tool between providers to facilitate recognition of patients with possible intracranial hemorrhage.

Background/Significance:
Intracranial hemorrhage is the “second leading cause of mortality in adult hematologic malignancy patients1.” Limited research exists on the clinical manifestations of intracranial hemorrhage in patients suffering from hematologic malignancies. The presence of thrombocytopenia makes it crucial to rapidly communicate and evaluate signs and symptoms. A clinical case of delayed head computed tomography scan served as the impetus to review patients diagnosed with intracranial hemorrhage.

Methods:
A comprehensive literature review of intracranial hemorrhage in adult hematologic malignancy patients was completed. After Institutional Review Board approval for an expedited retrospective matched case-control study, medical records of 27 hematologic malignancy inpatients with radiographically confirmed intracranial hemorrhage between 2011-2013 were reviewed. The inpatient stay of 27 matched controls were also reviewed. Signs and symptoms were analyzed by a statistician using t tests and Fisher's exact tests. Conditional logistic regression was used to estimate the relative risk for a set of potential exposure variables (nausea, hypertension, etc) on having an intracranial hemorrhage.

Results:
Demographics of our cases and controls were very similar and consisted of mean age 54, mostly white, half female, acute myelogenous leukemia patients undergoing induction therapy. Median average number of platelet transfusions and highest daily headache score were higher in our cases than controls and also statistically significant. Odds ratio showed that patients having prolonged prothrombin time, presence of cough, presence of vomiting, systolic blood pressure greater than 140, and systolic blood pressure greater than 160 were more likely to have an intracranial hemorrhage and were statistically significant. Average time to imaging from onset of first symptom was 40 hours.

Conclusions and Implications for Practice:
Final recommendations and communication tool are still in development as twelve additional patients and matched controls are still being reviewed. Current recommendation proposed from our findings include checking prothrombin times more frequently and more aggressively correcting them.