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All Journal Sriwijaya Journal of Surgery
Trijoso Permono
Department of Neurosurgery, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
Medicine & Pharmacology

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Mortality Predictors in Spontaneous Intracerebral Hemorrhage: External Validation of the ICH Score in the Indonesian Surgical Population Grady Christian; Trijoso Permono; Ziske Maritska
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.143

Abstract

Introduction: Spontaneous intracerebral hemorrhage (ICH) is a major contributor to stroke-related mortality and long-term disability, particularly in Indonesia, which faces the highest age-standardized stroke mortality rate in Southeast Asia. This study evaluates the predictive accuracy of the ICH Score for 30-day mortality among patients undergoing surgical intervention at a primary referral center in South Sumatra. Methods: This analytical observational study utilized a retrospective cohort design, analyzing 81 patients with spontaneous ICH who underwent surgical evacuation at Dr. Mohammad Hoesin Central General Hospital Palembang between July 2024 and June 2025. Demographic, clinical, and radiological parameters were evaluated. Accuracy was determined using Receiver Operating Characteristic (ROC) curve analysis to establish the Area Under the Curve (AUC), sensitivity, and specificity. Results: The cohort was predominantly male (56.8 percent) and aged under 80 years (86.4 percent). Significant predictors of 30-day mortality included age 80 years or older (p < 0.001, OR 26.84), lower Glasgow Coma Scale (GCS) scores (p = 0.012), and the presence of intraventricular hemorrhage (IVH) (p < 0.001, OR 15.24). ROC analysis demonstrated an AUC of 0.958 (95 percent CI 0.910–1.000). An optimal ICH Score cut-off of 3 or higher yielded a sensitivity of 86.2 percent and a specificity of 100 percent. Conclusion: The ICH Score serves as an exceptionally accurate prognostic tool in the Indonesian surgical population. An admission score of 3 or higher is a definitive predictor of mortality, facilitating risk stratification and informed clinical decision-making.
Marshall CT Classification as an Early Radiological Predictor of In-Hospital Mortality in Adult Surgical Traumatic Brain Injury: A Tertiary Indonesian Cohort Study Vandy Ikra; Trijoso Permono; Theodorus
Sriwijaya Journal of Surgery Vol. 9 No. 1 (2026): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v9i1.150

Abstract

Introduction: Computed tomography (CT) classification anchors surgical triage in traumatic brain injury (TBI), but contemporary Indonesian data on the prognostic performance of the Marshall CT score in surgically managed patients are scarce. Methods: An observational retrospective cohort study was conducted at Dr. Mohammad Hoesin Central General Hospital, Palembang. Consecutive adult surgical TBI patients operated on between January 2023 and December 2025 were enrolled. Marshall CT categories were assigned from non-contrast head CT scans by two independent raters (κ = 0.87). The primary outcome was in-hospital mortality. We quantified the association between Marshall score and in-hospital mortality using Spearman rank correlation, point-biserial correlation, penalised L2 logistic regression, and ROC analysis. Results: Thirty-six patients met the inclusion criteria (75.0% male; median age 25 years). In-hospital mortality was 19.4% (7/36; 95% CI 9.8–35.0%). Spearman correlation between Marshall score and mortality was ρ = 0.532 (95% CI 0.245–0.731, p = 0.001). Marshall category was an independent predictor in penalised logistic regression (adjusted OR 3.12, 95% CI 1.63–4.41; p = 0.013). ROC AUC was 0.852 (95% CI 0.724–0.960), numerically superior to admission GCS AUC of 0.778 (DeLong p = 0.298). Conclusion: Marshall CT classification is an independent, point-of-CT predictor of in-hospital mortality after surgery for TBI in an Indonesian tertiary cohort. Integration into structured operative triage may enhance early risk stratification.
Co-Authors Grady Christian Theodorus Theodorus Vandy Ikra Ziske Maritska