New Prediction Models of Functional Outcome in Acute Intracerebral Hemorrhage: The dICH Score and uICH Score

Abstract

Objectives: The original intracerebral hemorrhage (oICH) score is the severity score most commonly used in clinical intracerebral hemorrhage (ICH) research but may be influenced by hematoma expansion or intraventricular hemorrhage (IVH) growth in acute ICH. Here, we aimed to develop new clinical scores to improve the prediction of functional outcomes in patients with ICH.Methods: Patients admitted to the First Affiliated Hospital of Chongqing Medical University with primary ICH were prospectively enrolled in this study. Hematoma volume was measured using a semiautomated, computer-assisted technique. The dynamic ICH (dICH) score was developed by incorporating hematoma expansion and IVH growth into the oICH score. The ultra-early ICH (uICH) score was developed by adding the independent non-contrast CT markers to the oICH score. Receiver operating characteristic curve analysis was used to compare performance among the oICH score, dICH score, and uICH score.Results: This study included 76 patients (23.3%) with hematoma expansion and 61 patients (18.7%) with IVH growth. Of 31 patients with two or more non-contrast computed tomography markers, 61.3% died, and 96.8% had poor outcomes at 90 days. After adjustment for potential confounding variables, we found that age, baseline Glasgow Coma Scale score, presence of IVH on initial CT, baseline ICH volume, infratentorial hemorrhage, hematoma expansion, IVH growth, blend sign, black hole sign, and island sign could independently predict poor outcomes in multivariate analysis. In comparison with the oICH score, the dICH score and uICH score exhibited better performance in the prediction of poor functional outcomes.Conclusions: The dICH score and uICH score were useful clinical assessment tools that could be used for risk stratification concerning functional outcomes and provide guidance in clinical decision-making in acute ICH.

Research advances in imaging markers for predicting hematoma expansion in intracerebral hemorrhage: a narrative review

“…They indicated that the score system had reliable accuracy in predicting HE, and NCCT imaging markers may serve as the key for HE prediction. Yang et al ( 94 ) put forward a new prediction models of functional outcome in acute ICH patients, named ultra-early ICH score, containing admission GCS score (3–4: 2 points; 5–12: 1point), baseline ICH volume ˃ 30 ml (1 point), positive IVH (1 point), infratentorial hemorrhage (1 point), age ≥ 80 (1 point), positive BS (1 point), positive BHS (1 point), and positive IS (1 point). Their results showed that the ultra-early ICH score was a useful clinical assessment tool for risk stratification concerning functional outcomes and provided guidance in clinical decision-making in acute ICH.…”

A Modified ICH Scoring Model to Predict Functional Outcomes in Primary Intracerebral Hemorrhage Survivors-Prospective Study

“…Patients with ICH exhibit greater improvement in the subacute phase up to 3 months postincident compared with patients who had ischemic stroke, indicating the importance of training and identi cation of the high-risk population (2). Several predictive models for ICH mortality and functional outcomes have been developed and widely used since 2001 (3)(4)(5)(6)(7)(8)(9)(10)(11). These tools are potentially useful for determining prognosis, selecting patients for potential interventions, and developing individualized treatment strategies (12).…”