Usefulness of Modified Cave (Cave2) Score To Identify Seizure in Adult Patients with Intracerebral Hemorrhage (Ich) In Emergency Room

Abstract

Introduction: Seizure is a common neurological disorder causing physical, psychological, emotional, social, and economic effects. Seizure is a serious complication of spontaneous intracerebral hemorrhage (ICH), which can cause significant disability and mortality. The purpose of the study is to determine the frequency of post-ICH seizure, possible associated factors, and use the modified CAVE score (CAVE2) to identify seizures (mainly late seizures) and assess outcomes in terms of mortality at Devdaha Medical College and Research Institute (DMCRI), Nepal.

Methods: This was a descriptive cross-sectional hospital-based study conducted among adult patients attending the emergency room of DMCRI from January 2025 to July 2025 over a six-month period. The study commenced after obtaining ethical approval from the Institutional Review Committee (Reference No: 21/2024). The inclusion criteria consisted of adult patients aged 18 years or above with ICH bleed diagnosed based on history, examination, and CT head, and admitted for complete neurological intervention. Collected data was collected using structured questionnaires, and analysis was performed by using Microsoft Excel and SPSS V.21. C-statistics (ROC) were calculated, and a 95 % confidence interval was taken.

Results:  A total of 73 cases between 18 and 86 years of ICH were included. 43 (59%) were male, and 30 (41%)were female. Mean duration of Hospital stay was 17 days (SD±3.74) with a maximum of 47 days and a minimum of 9 days.  Late seizure was developed in 14 patients (19.17%), whereas early seizure was in 8 (10.9%) patients. Late seizure was 100% in a hypertensive patient with ICH bleed, followed by a smoker (92.8%) and an alcohol consumer (85.7%). Calculated CAVE2 scores with seizure percentage: 0 (0%), 1(5.5%), 2(16.6%),3(25%),4(83.3%), and 5(100%). The calculated C-statistic (ROC) for the CAVE2 scores was 0.87. In the hospital, the mortality rate was 26% (n=19).

Conclusion: The CAVE2 score can identify patients with a high risk of late seizures. The higher the score, the higher the risk of getting seizures in the future. The CAVE-2 score in the emergency room helps triage patients and guide treatment.