Accuracy and Clinical Usefulness of Intracerebral Hemorrhage Grading Scores

Abstract

Background and Purpose-Various grading scores to predict survival after intracerebral hemorrhage (ICH) have been described. We aimed to test the accuracy and clinical usefulness of 3 well-known scores (original ICH score, modified ICH score, and ICH grading scale) in a large unselected cohort of typical ICH patients. Methods-A total of 1364 ICH cases were referred to our center from January 1, 2008, to October 17, 2010 were prospectively recorded, and the first computed tomography brain scan was retrospectively reviewed to determine ICH volume and location and to identify intraventricular hemorrhage. The original ICH, ICH grading scale, and modified ICH score were calculated. Receiver operating characteristic and decision curves for 30-day mortality were generated. Results-A total of 1175 patients were included in the final analysis. All 3 scores and the Glasgow Coma Scale (GCS) divided cases into groups with highly significant differences in mortality. The area under the receiver operating characteristic curve was very similar for original ICH (0.861), ICH grading scale (0.874), and GCS (0.872), but was less for modified ICH score (0.824). Age was much less predictive (0.565). Combining GCS with age, log ICH volume, and intraventricular hemorrhage to derive a multifactorial risk of death at 30 days significantly increased the area under the receiver operating characteristic curve (0.897). All scores and GCS demonstrated a similar net benefit for threshold probabilities of 10% to 95%. Above 95%, the net benefit of GCS became inferior to the prognostic scores. Conclusions-Although existing grading scores are highly predictive of 30-day mortality, GCS alone was as predictive in our cohort, but age was not.

Cancer is an independent predictor of poor outcomes in patients following intracerebral hemorrhage

“…Table 2 shows the detailed characteristics of the patients with ICH. The median (IQR) time from stroke onset to admission and GCS score on admission were 1.9 (0.8-9.7) h and 12 (7)(8)(9)(10)(11)(12)(13)(14)(15), respectively. Ninety-nine patients (24.8%) were using antithrombotic agents When compared to patients without cancer, patients with cancer had a longer time from stroke onset to admission, a lower prevalence of hypertension and diabetes mellitus, lower hemoglobin levels, and poorer prestroke, 30-day and 90-day mRS scores, respectively.…”

“…neurological symptoms, hematoma volume and location of hemorrhage) were not evaluated [13]. In this study, the relationship between cancer and ICH outcomes was examined using an ordinal logistic regression analysis, and it was revealed that cancer was associated with poorer outcomes following ICH, independent of known prognostic factors [3][4][5][6][7][8][9][10][11][12]. When the analysis was performed using data from individuals with localized cancer, the effects remained significant after assessment using 90-day mRS but not after that using 30-day mRS.…”

“…The prognosis following ICH depends on factors including age [3][4][5][6], sex [5,6], prior use of antithrombotic agents [4,7,8], Glasgow Coma Scale (GCS) score [3,5,6,9,10], hematoma volume [5,6,10,11], infratentorial location [3] and intraventricular hemorrhage extension [3,12].…”

“…ICH is a late complication in most patients with cancer [16], and a majority of patients with cancer die from progression of the underlying cancer [17]. Therefore, concern has arisen that the presence of cancer may be associated with poor outcomes following ICH, irrespective of previously reported prognostic factors [3][4][5][6][7][8][9][10][11][12]. However, few data are available on the relationship between cancer and outcomes following ICH, and the relevance of cancer to the prognosis of ICH remains unclear.…”

A few realistic questions raised by organ retrieval in the intensive care unit

“…One potential explanation is that prognostic indices based on several factors in combination may predict outcome with better accuracy in neuro-critical care than in other areas in medicine (54)(55)(56)(57)(58). For patients with congestive heart failure, obstructive bronchitis, cirrhosis, kidney disease or cancer, it is rarely possible to prognosticate with certainty that a chronically ill subject will not survive an acute episode (59).…”