Novel Score for Stratifying Risk of Critical Care Needs in Patients With Intracerebral Hemorrhage

Abstract

Objective:To develop a risk prediction score identifying intracerebral hemorrhage (ICH) patients at low risk for critical care.Methods:We retrospectively analyzed data of 451 ICH patients between 2010-2018. The sample was randomly divided in a development and a validation cohort. Logistic regression was used to develop a risk score by weighting independent predictors of ICU needs based on strength of association. The risk score was tested in the validation cohort, and externally validated in a dataset from another institution.Results:The rate of ICU interventions was 80.3%. Systolic blood pressure (SBP), Glasgow Coma Scale (GCS), intraventricular hemorrhage (IVH), and ICH volume were independent predictors of critical care, resulting in the following point assignments for the INtensive care TRiaging IN Spontaneous IntraCerebral hemorrhage (INTRINSIC) score: SBP 160-190 mm Hg (1 point), SBP >190 mm Hg (3 points); GCS 8-13 (1 point), GCS <8 (3 points); ICH volume 16-40 cm3 (1 point), ICH volume >40 cm3 (2 points); and presence of IVH (1 point), with values ranging between 0-9. Among patients with a score of 0 and no ICU needs during their emergency department stay, 93.6% remained without critical care needs. In an external validation cohort of ICH patients, the INTRINSIC score achieved an AUC of 0.823 (95% CI 0.782-0.863). A score <2 predicted absence of critical care needs with 48.5% sensitivity and 88.5% specificity, and a score <3 predicted absence of critical care needs with 61.7% sensitivity and 83.0% specificity.Conclusion:The INTRINSIC score identifies ICH patients at low risk for critical care interventions.Classification of Evidence:This study provides Class II evidence that the INTRINSIC score identifies ICH patients at low risk for critical care interventions.

Radiomics features from perihematomal edema for prediction of prognosis in the patients with basal ganglia hemorrhage

“…The GCS has been widely used in clinical research to assess and calculate the level of consciousness of patients (29)(30)(31). In line with our results, the GCS score has been shown to be strongly associated with the outcome of basal ganglia hemorrhage patients and is an independent predictor of critical care (32,33). Similar to the previous studies, plasma DD2 could predict poor outcome and mortality in ICH patients (34)(35)(36).…”

Admission Dehydration Status Portends Adverse Short-Term Mortality in Patients with Spontaneous Intracerebral Hemorrhage

“…Despite a variety of potential therapeutic approaches (e.g., blood pressure control, aspiration, decompressive craniectomy), the outcome (in this case, 30-day mortality) of ICH is often considered poor [3][4][5][6][7]. In addition to the consequences of the hemorrhage on the outcome/mortality of patients with ICH, intensive care therapy addresses additional risk factors/comorbidities unrelated to the hemorrhage [8]. These may include prolonged mechanical ventilation and the need for renal replacement therapy, among other complications of intensive care [9][10][11].…”

Rational Utilization of Critical Care Services for Intracerebral Hemorrhage

“…3,4 Patients arriving with delay due to late presentation or interhospital transfer with no observable critical care needs may have already declared themselves appropriate for an intermediate care unit. The INTRINSIC score may also find application in selectively shortening ICU observation intervals for lower-risk patients who do not need critical care interventions within the first 12 hours.…”

“…In this issue of Neurology ®, Faigle et al 3 provide data to guide the triage of ICU needs for patients with intracerebral hemorrhage (ICH), a heterogenous but generally high-risk population. They developed a simple prediction score (Intensive Care Triaging in Spontaneous Intracerebral Hemorrhage [INTRINSIC]) that is based on commonly measured clinical variables and externally validated its accuracy using data from a separate institution.…”

“…Most critical care needs for patients with ICH become evident in the emergency department, and prior research has shown that the majority of major neurologic deterioration events that influence outcomes happen within the first 12 hours after symptom onset. 3,4 Patients arriving with delay due to late presentation or interhospital transfer with no observable critical care needs may have already declared themselves appropriate for an intermediate care unit. The INTRINSIC score may also find application in selectively shortening ICU observation intervals for lower-risk patients who do not need critical care interventions within the first 12 hours.…”