The
Relationship Between Hematoma Volume and Lesion Location with the Level of
Consciousness in Hemorrhagic Stroke Patients at Gunung Jati Regional Hospital,
Cirebon, in 2024
Tubagus Syahrul Ramdani1*, Dasa Sariadi2, Hendry Gunawan3
1,2,3Universitas
Swadaya Gunung Jati, Cirebon, Indonesia
Email: tubagussyahrulr@gmail.com
KEYWORDS |
ABSTRACT |
Hematoma Volume, Hematoma Lesion Location, Level of
Consciousness |
A stroke is defined as an acute clinical manifestation of
neurological dysfunction that persists for ≥ 24 hours. WHO states that
in 2018, there were an estimated 50 million stroke patients worldwide, and
every year, there are an additional 13.7 million stroke cases. Intracerebral
Hemorrhage (ICH) is one of the most severe and fatal subtypes of
cerebrovascular haemorrhage. The volume of bleeding and the location of the
hematoma lesion are two things that can affect patient mortality. To analyze
the relationship between the volume and location of hematoma lesions with the
level of consciousness of hemorrhagic stroke patients at Gunung Jati Regional
Hospital Cirebon in 2024. This study is an analytic observational study with
a cross-sectional approach. Data collection using total sampling in
accordance with the inclusion criteria of as many as 40 samples. The
population in this study consists of hemorrhagic stroke patients at Gunung
Jati Regional Hospital Cirebon in 2024. The data that has been collected is
processed using univariate and bivariate analysis. Bivariate analysis using
the Spearman test. The hematoma volume was ≤ 30 mL and the lesion
location was in the parietal lobe. The results of
the analysis of the volume of hematoma with the level of consciousness
obtained a p-value of 0.000 (≤ 0.05) with an R-value of 0.529, showing
a significant relationship with fairly strong strength and positive
relationship direction. As for the location of the hematoma lesion with the
level of consciousness, the p-value is 0.007 (≤ 0.05) with an R-value
of 0.422, indicating a relationship with fairly strong strength and negative
relationship direction. There is a significant relationship between the
volume and location of hematoma lesions and the level of consciousness of
hemorrhagic stroke patients. |
DOI:
10.58860/ijsh.v3i11.268 |
|
Corresponding
Author: Tubagus Syahrul Ramdani*
Email: tubagussyahrulr@gmail.com
INTRODUCTION
Stroke is
something that is highly feared by the public because of the long-term effects
that can cause significant or irreversible damage
According to
the results of the 2019 Global Burden of Disease study, stroke is the leading
cause of disability-adjusted life year in those aged 50 years and over
Indonesia
itself is the largest contributor to stroke disease in Asian countries, even
according to World Life Expectancy, Indonesia is ranked first with the highest
number of stroke diseases in the world, it is estimated that every year
Indonesia experiences an increase in new stroke patients with a total of
550,000 people, with the death rate due to this stroke disease reaching 138,264
Intracerebral
Hemorrhage (ICH) is one of the most severe and fatal subtypes of
cerebrovascular haemorrhage and is associated with a mortality rate of up to
40%
METHOD
This study is an analytic observational research with a cross-sectional
approach, conducted at Gunung Jati Cirebon Regional Hospital from May to June
2024. The study aimed to analyze hemorrhagic stroke cases using medical records
of patients diagnosed with intracerebral hemorrhage stroke. The population of
this study consisted of patients diagnosed with intracerebral hemorrhagic
stroke at Gunung Jati Cirebon Regional Hospital from January to June 2024.
The sampling
technique used in this study was purposive sampling, where participants were
selected based on specific inclusion and exclusion criteria. The inclusion
criteria for this study were: (1) patients diagnosed with intracerebral haemorrhage
stroke at Gunung Jati Cirebon Regional Hospital between January and June 2024,
(2) patients experiencing their first attack of intracerebral haemorrhage
stroke, and (3) patients with complete medical records. The exclusion criteria
included (1) patients with CT scan results indicating brain ischemia, (2)
subarachnoid haemorrhage (SAH) patients, and (3) patients with intracerebral
haemorrhage due to trauma.
Data
collection was performed by reviewing the medical records of eligible patients.
The data gathered included patient demographics, clinical history, imaging
results, and other relevant medical information. Data analysis was conducted
using descriptive statistics to summarize the characteristics of the sample, as
well as inferential statistics to examine relationships and differences between
variables. This study has received ethical approval from the Research Ethics
Committee of Gunung Jati Cirebon Regional Hospital (No.
021/LAIKETIK/KEPPKRSGJ/V/2024) and adheres to ethical research guidelines.
RESULT AND DISCUSSION
Table 1. Frequency
distribution of samples based on bleeding volume
No. |
Criteria |
Frequency |
Percentage
(%) |
1 |
Lesion volume ≤ 30 mL |
34 |
85.0 |
2 |
Lesion volume > 30 mL |
6 |
15.0 |
|
Total |
40 |
100 |
For data on
samples with bleeding volume categories, the most samples were samples with
lesion volume ≤ 30 mL, as many as 34 samples (85%) more than with lesion
volume > 30 mL as many as 6 samples (15%).
Table 2.
Frequency distribution of samples based on the location of bleeding lesions
No. |
Criteria |
Frequency |
Percentage
(%) |
1 |
Frontis |
8 |
20.0 |
2 |
Parietal |
20 |
50.0 |
3 |
Temporalis |
7 |
17.5 |
4 |
Occipitalis
|
5 |
12.5 |
|
Total |
40 |
100 |
Sample data
with the category of hematoma lesion location is divided into 4 lobes, namely
Frontalis, Parietalis, Temporalis, and Occipitalis. The location of the
bleeding lesion with the most samples was the Parietal Lobe with 20 samples
(50%), followed by the second most in the Frontalis Lobe with 8 samples (20%),
then the Temporalis Lobe with 7 samples (17.5%), and the last sample was in the
Occipitalis lobe with 5 samples (12.5%).
Table 3.
Frequency Distribution of Samples Based on the Glass Glow Coma Scale
No. |
Criteria |
Frequency |
Percentage
(%) |
1 |
GCS
15: Compos Mentis |
22 |
55.0 |
2 |
GCS
12-14: Somnolent |
1 |
2.50 |
3 |
GCS
8-11: Sopor |
6 |
15.0 |
4 |
GCS
3-7: Coma |
11 |
27.5 |
|
Total |
40 |
100 |
Level of
consciousness based on GCS, the most samples were GCS 15 with 22 samples (55%),
followed by GCS 3-7 with 11 samples (27.5%), then GCS 8-11 with 6 samples
(15%), and the least samples were GCS 12-14 with 1 sample (2.5%).
Table 4.
Bivariate Analysis Between Hematoma Volume and Level of Consciousness
Hematoma Volume |
Awareness Level |
Total |
p-value |
r |
||||
GCS 15 |
GCS 12-14 |
GCS 8-11 |
GCS 3-7 |
|||||
≤30 mL |
n |
22 |
1 |
5 |
6 |
34 |
0.000 |
0,529 |
% |
55.0 |
2.5 |
12.5 |
15 |
85.0 |
|||
>30 mL |
n |
0 |
0 |
1 |
5 |
6 |
||
% |
0.0 |
0.0 |
2.5 |
12,5 |
15.0 |
|||
Total |
n |
22 |
1 |
6 |
11 |
40 |
||
% |
55.0 |
2.5 |
15.0 |
27.5 |
100.0 |
Based on crosstab
analysis, the distribution of sample data with Hematoma Volume ≤ 30 mL
was 34 samples with details of 22 samples (55%) having a compos mentis level of
consciousness, 1 sample (2.5%) had a somnolent level of consciousness, 5
samples (27.5%) had a sopor level of consciousness and 6 samples (15%) had a
coma level of consciousness. As for sample data with Hematoma Volume > 30
mL, there were no samples with the category of compos mentis and somnolent
level of consciousness, but 1 sample (2.5%) with sopor level of consciousness
and 5 samples (12.5%) with coma level of consciousness were obtained.
The results
of the Spearman correlation statistical test between hematoma volume and the
level of consciousness of hemorrhagic stroke patients at Gunung Jati Regional
Hospital obtained a p-value of 0.000 (≤ 0.05) so that H0 was rejected,
and H1 was accepted, with a correlation coefficient value of 0.529 with
moderate strength and positive relationship direction where the higher the
volume of bleeding, the more GCS decrease. Thus, it is concluded that there is
a significant relationship between hematoma volume and the level of
consciousness of hemorrhagic stroke patients at Gunung Jati Regional Hospital
in 2024.
Table 5.
Bivariate analysis between hematoma volume and level of consciousness
Awareness Level |
Total |
p-value |
r |
|||||
GCS 15 |
GCS 12-14 |
GCS 8-11 |
GCS 3-7 |
|||||
Frontal Lobe |
n |
2 |
0 |
3 |
3 |
8 |
0.007 |
-0,422 |
% |
5.0 |
0.0 |
7.5 |
7.5 |
20.0 |
|||
Parietal Lobe |
n |
9 |
1 |
3 |
7 |
20 |
||
% |
22.5 |
2.5 |
7.5 |
17.5 |
50.0 |
|||
Temporalis lobe |
n |
7 |
0 |
0 |
0 |
7 |
||
% |
17.5 |
0.0 |
0.0 |
0.0 |
17.5 |
|||
Occipital Lobe |
n |
4 |
0 |
0 |
1 |
5 |
||
% |
10.0 |
0.0 |
0.0 |
2.5 |
12.5 |
|||
Total |
n |
22 |
1 |
6 |
11 |
40 |
||
% |
55.0 |
2.5 |
15.0 |
27.5 |
100.0 |
The
distribution of sample data on the location of hematoma lesions in the frontal
lobe with details of 2 samples (5%) had a compos mentis level of consciousness,
3 samples (7.5%) had a sopor level of consciousness, 3 samples (7.5%) had a
coma level of consciousness, and no samples were found with a somnolent level
of consciousness category. Sample data with the location of hematoma lesions in
the parietal lobe with details of 9 samples (22.5%) had a compos mentis level
of consciousness, 1 sample (2.5%) had a somnolent level of consciousness, 3
samples (7.5%) had a sopor level of consciousness, and 7 samples (17.5%) had a
coma level of consciousness. Data on samples with hematoma lesions in the
temporal lobe with details of 7 samples (17.5%) had a compos mentis level of
consciousness, and there were no samples with somnolent, sopor and coma level
of consciousness categories. While sample data with the location of hematoma
lesions in the occipital lobe with details of 4 samples (10%) had a compos
mentis level of consciousness, 1 sample (2.5%) had a coma level of
consciousness, and no samples were obtained with the categories of somnolent
and sopor levels of consciousness.
The results
of the Spearman statistical test between the location of the hematoma lesion
and the level of consciousness of hemorrhagic stroke patients at Gunung Jati
Regional Hospital obtained a p-value of 0.007 (≤ 0.05) H0 rejected, and
H1 accepted, with a correlation coefficient value of 0.422 with moderate
strength and negative relationship direction. Then the conclusion is. Thus, it
is concluded that there is a relationship between the location of the hematoma
lesion and the level of consciousness of hemorrhagic stroke patients at Gunung
Jati Regional Hospital in 2024.
A. Analysis of the Relationship Between Hematoma Volume and
Consciousness Level of Hemorrhagic Stroke Patients
The
relationship between bleeding volume and the level of consciousness of stroke
patients can be seen in Table 4. The results showed that intracerebral haemorrhage
patients with a compos mentis level of consciousness had an average volume of
≤ 30 mL, while patients who experienced coma had an average volume of
bleeding > 30 mL. These results are in line with research by Arifin et al.
(2020), which shows that bleeding volumes ≥ 30 cc are almost six times
more at risk of death within 30 days
This is
also in accordance with research conducted by Maria Ulfa et al.
B.
Analysis of the Relationship
between Hematoma Lesion Location and Consciousness Level of Hemorrhagic Stroke
Patients
The
relationship between the location of hematoma lesions and the level of
consciousness of hemorrhagic stroke patients can be seen in Table 5. The
results showed that intracerebral haemorrhage patients with the most
compliments level of consciousness were found in the parietal lobe
In
addition, another study conducted by Kay-Cheong Teo et al.
Decreased
consciousness or coma is caused by structural or metabolic damage to the
brainstem ARAS or damage to bilateral cerebral cortical sections
CONCLUSION
The volume and
location of hematomas may influence the level of consciousness in patients.
This study aims to examine the relationship between hematoma volume, lesion
location, and the level of consciousness. The objective of this study is to
assess the relationship between hematoma volume and the level of consciousness,
as well as to analyze how the location of the hematoma lesion correlates with
the level of consciousness in patients. The majority of hematomas are found to
have a volume of ≤ 30 mL, with the lesions predominantly located in the
parietal lobe. Statistical analysis of the relationship between hematoma volume
and the level of consciousness reveals a p-value of 0.000 (≤ 0.05) and an
R-value of 0.529, indicating a significant and fairly strong positive
correlation. In contrast, the analysis of the relationship between the location
of the hematoma lesion and the level of consciousness shows a p-value of 0.007
(≤ 0.05) and an R-value of 0.422, indicating a significant, fairly strong
negative correlation.
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