Editors' Note: Novel Score for Stratifying Risk of Critical Care Needs in Patients With Intracerebral Hemorrhage

Neurology ◽  
2021 ◽  
Vol 97 (15) ◽  
pp. 745.1-745
Author(s):  
James E. Siegler ◽  
Steven Galetta
Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011927
Author(s):  
Roland Faigle ◽  
Bridget J. Chen ◽  
Rachel Krieger ◽  
Elisabeth B. Marsh ◽  
Ayham Alkhachroum ◽  
...  

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.


Neurology ◽  
2021 ◽  
Vol 97 (15) ◽  
pp. 747.1-747
Author(s):  
Noushin Chini Foroush ◽  
Peter Kempster ◽  
Udaya Seneviratne

Neurology ◽  
2021 ◽  
Vol 97 (15) ◽  
pp. 745.2-746
Author(s):  
Nikhil M. Patel ◽  
Quincy K. Tran ◽  
Neeraj Badjatia ◽  
Nicholas A. Morris

2016 ◽  
Vol 32 ◽  
pp. 3-8 ◽  
Author(s):  
Roland Faigle ◽  
Elisabeth B. Marsh ◽  
Rafael H. Llinas ◽  
Victor C. Urrutia ◽  
Rebecca F. Gottesman

PEDIATRICS ◽  
1987 ◽  
Vol 79 (5) ◽  
pp. 836-837
Author(s):  
GERALD KATZMAN

To the Editor.— There have been several attempts to define the person-power needs for neonatologists in the United States.1-3 The reports by Merenstein et al2 and the AAP Committee on Fetus and Newborn1 maintain that there is presently an adequate number of neonatologists, whereas in a 1981 editorial, Robertson3 predicted increasing shortages of neonatologists. Why the difference between the conclusions? My answer to this question is that the reports by Merenstein et al and the AAP used calculated ratios of neonatologists to live births or lengths of stay, whereas the Robertson editorial expressed concern about the critical care needs of the physiologically unstable neonate.


2020 ◽  
Vol 117 (18) ◽  
pp. 9696-9698 ◽  
Author(s):  
Jennifer Beam Dowd ◽  
Liliana Andriano ◽  
David M. Brazel ◽  
Valentina Rotondi ◽  
Per Block ◽  
...  

Governments around the world must rapidly mobilize and make difficult policy decisions to mitigate the coronavirus disease 2019 (COVID-19) pandemic. Because deaths have been concentrated at older ages, we highlight the important role of demography, particularly, how the age structure of a population may help explain differences in fatality rates across countries and how transmission unfolds. We examine the role of age structure in deaths thus far in Italy and South Korea and illustrate how the pandemic could unfold in populations with similar population sizes but different age structures, showing a dramatically higher burden of mortality in countries with older versus younger populations. This powerful interaction of demography and current age-specific mortality for COVID-19 suggests that social distancing and other policies to slow transmission should consider the age composition of local and national contexts as well as intergenerational interactions. We also call for countries to provide case and fatality data disaggregated by age and sex to improve real-time targeted forecasting of hospitalization and critical care needs.


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