Validation of the newly conceived Surgical Swedish ICH grading scale for surgically treated patients with intracerebral hemorrhage: patient series

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Johan A. Haga ◽  
Frantz R. Poulsen ◽  
Axel Forsse
Keyword(s):  
Intracerebral Hemorrhage ◽  
Area Under Curve ◽  
Mortality Rates ◽  
Patient Records ◽  
Patient Series ◽  
Grading Scale ◽  
One Year ◽  
Ich Score ◽  
Receiver Operator Characteristics ◽  
Clinical Grading

BACKGROUNDThe authors sought to externally validate a newly developed clinical grading scale, the Surgical Swedish ICH (SwICH) score. Patients surgically treated for spontaneous supratentorial intracerebral hemorrhage (ICH) from 2009 to 2019 in a single center in Denmark were identified. Data were retrospectively collected from patient records and neuroimaging. Surgical SwICH and ICH scores were calculated for each patient, and the validity of the Surgical SwICH was assessed and compared.OBSERVATIONSThe 126 patients included had an overall 30-day mortality rate of 23%. All patients with a Surgical SwICH score of 0 survived past one year. No patient scored the maximum Surgical SwICH score of 6. The 30-day mortality rates for Surgical SwICH scores 1, 2, 3, and 4 were 0%, 20%, 53%, and 25%, respectively (p <0.0001 for trend). Mortality rates for ICH scores 1, 2, 3, and 4 were 0%, 11%, 33%, and 76%, respectively (p <0.001 for trend). Receiver operator characteristics showed an area under curve of 0.78 for the Surgical SwICH score and 0.80 for the ICH score (p = 0.21 difference).LESSONSThe Surgical SwICH score was a good predictor of 30-day mortality in patients surgically treated for spontaneous supratentorial ICH. However, the Surgical SwICH score did not outperform the previously established ICH score in predicting 30-day mortality.

A grading scale for surgically treated patients with spontaneous supratentorial intracerebral hemorrhage: the Surgical Swedish ICH Score

2020 ◽  
Vol 133 (3) ◽  
pp. 800-807 ◽  
Author(s):  
Andreas Fahlström ◽  
Henrietta Nittby Redebrandt ◽  
Hugo Zeberg ◽  
Jiri Bartek ◽  
Andreas Bartley ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Intracerebral Hemorrhage ◽  
External Validation ◽  
Grading Scale ◽  
Ich Score ◽  
Gcs Score ◽  
Strength Of Association ◽  
Point Type ◽  
Clinical Grading

OBJECTIVEThe authors aimed to develop the first clinical grading scale for patients with surgically treated spontaneous supratentorial intracerebral hemorrhage (ICH).METHODSA nationwide multicenter study including 401 ICH patients surgically treated by craniotomy and evacuation of a spontaneous supratentorial ICH was conducted between January 1, 2011, and December 31, 2015. All neurosurgical centers in Sweden were included. All medical records and neuroimaging studies were retrospectively reviewed. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the Surgical Swedish ICH [SwICH] Score) was developed using weighting of independent predictors based on strength of association.RESULTSFactors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score (p = 0.00015), ICH volume ≥ 50 mL (p = 0.031), patient age ≥ 75 years (p = 0.0056), prior myocardial infarction (MI) (p = 0.00081), and type 2 diabetes (p = 0.0093). The Surgical SwICH Score was the sum of individual points assigned as follows: GCS score 15–13 (0 points), 12–5 (1 point), 4–3 (2 points); age ≥ 75 years (1 point); ICH volume ≥ 50 mL (1 point); type 2 diabetes (1 point); prior MI (1 point). Each increase in the Surgical SwICH Score was associated with a progressively increased 30-day mortality (p = 0.0002). No patient with a Surgical SwICH Score of 0 died, whereas the 30-day mortality rates for patients with Surgical SwICH Scores of 1, 2, 3, and 4 were 5%, 12%, 31%, and 58%, respectively.CONCLUSIONSThe Surgical SwICH Score is a predictor of 30-day mortality in patients treated surgically for spontaneous supratentorial ICH. External validation is needed to assess the predictive value as well as the generalizability of the Surgical SwICH Score.

scholarly journals 30-days’ outcome of haemorrhagic stroke: correlation between intracerebral hemorrhage score and modified Rankin score

Mediscope ◽  
2018 ◽  
Vol 5 (1) ◽  
pp. 10-14
Author(s):  
AH Sarder ◽  
BK Das ◽  
KJ Mondal ◽  
MA Kabir ◽  
B Basu ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Haemorrhagic Stroke ◽  
Tertiary Hospital ◽  
Modified Rankin Scale ◽  
Grading Scale ◽  
Ich Score ◽  
Clinical Grading

Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes. Within 30 days reported mortality is 35-52% and only 20% is functionally independent in 6 months. Despite several existing outcome prediction models for ICH, modified Rankin scale is found to be best predictor of outcome in early and long term period. To find out 30-day mortality in ICH and predict outcome based on modified Rankin score. In this study, 48 patients presenting with acute ICH presenting to a tertiary hospital in Khulna were enrolled. The 30-day mortality and disability were recorded, and ICH score along with modified Rankin score at presentation were calculated. In this study, the 30-day mortality rate was 27.1%; regression analysis showed the correlation between the scores (as measured by modified Rankin scale) for patient disability, intraventricular hemorrhage, the Glasgow Coma score, and volume of hematoma (>30 ml vs <30 ml) were significantly correlated with corresponding ICH scores. The ICH scale is a simple clinical grading scale which can predict mortality as well as disability in haemorrhagic stroke within 30 days that can be helpful to physicians in prioritization of their patient management and forecasting about prognosis.Mediscope Vol. 5, No. 1: Jan 2018, Page 10-14

STUDY OF&NBSP; PRONOSTIC FACTORS AFTER 30 DAYS IN PATIENTS WITH INTRACRANIAL HEMORRAGIA

2016 ◽  
pp. 68-73
Author(s):  
Thi Kieu Diem Tran ◽  
Dinh Toan Nguyen
Keyword(s):  
Ischemic Stroke ◽  
Mortality Rate ◽  
Intracerebral Hemorrhage ◽  
Prediction Models ◽  
Treatment Protocols ◽  
Pronostic Factors ◽  
Key Words Intracerebral Hemorrhage ◽  
Grading Scale ◽  
Ich Score ◽  
Clinical Grading

Background and purpose: Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes and remains without a treatment of proven benefit. Despite several existing outcome prediction models for ICH, there is no standard clinical grading scale for ICH analogous to those for traumatic brain injury, subarachnoid hemorrhage, or ischemic stroke. Methods: Records of all patients with acute ICH presenting to the Neurology Department, Binh Dinh General Hospital from July 2014-March 2015. Clinical outcome assessed by mRankin score and was compared with each item of ICH scale. ROC-AUC was realized to evaluated the value of ICH in prognostic the outcome of cerebral hemorrhage at day 30. Results: In the day 30: mortality rate was evaluated compared with mRS: In the group with ICH 0-1: no mortality, good outcome was 92.8% and 72.7%. ICH 2-3: mortlity rate increased 47.9% and 84.4%. ICH 4-5: mortality rate 100%. The prognostic predictor of ICH was high with Se 95%, Sp 59%. ROC-AUC 0.908, p<0.0001. Conclusions: The ICH Score is a simple clinical grading scale that allows risk stratification on presentation with ICH. The use of a scale such as the ICH Score could improve standardization of clinical treatment protocols and clinical research studies in ICH. Key words: Intracerebral hemorrhage (ICH), ischemic stroke

scholarly journals Determining ICH Score: can we go beyond?

2009 ◽  
Vol 67 (3a) ◽  
pp. 605-608 ◽  
Author(s):  
Gustavo Cartaxo Patriota ◽  
João Manoel da Silva-Júnior ◽  
Alécio Cristino Evangelista Santos Barcellos ◽  
Joaquim Barbosa de Sousa Silva Júnior ◽  
Diogo Oliveira Toledo ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Auxiliary Variable ◽  
Accurate Information ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Great Heterogeneity ◽  
One Year ◽  
The One ◽  
Ich Score ◽  
Reliable Scale

Spontaneous intracerebral hemorrhage (SICH) still presents a great heterogeneity in its clinical evaluation, demonstrating differences in the enrollment criteria used for the study of intracerebral hemorrhage (ICH) treatment. The aim of the current study was to assess the ICH Score, a simple and reliable scale, determining the 30-day mortality and the one-year functional outcome. Consecutive patients admitted with acute SICH were prospectively included in the study. ICH Scores ranged from 0 to 4, and each increase in the ICH Score was associated with an increase in the 30-day mortality and with a progressive decrease in good functional outcome rates. However, the occurrence of a pyramidal pathway injury was better related to worse functional outcome than the ICH Score. The ICH Score is a good predictor of 30-day mortality and functional outcome, confirming its validity in a different socioeconomic populations. The association of the pyramidal pathway injury as an auxiliary variable provides more accurate information about the prognostic evolution.

scholarly journals The CLASS Surgical Site Characteristics in a Clinical Grading Scale and Anterior Segment Optical Coherence Tomography: A One-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-13
Author(s):  
Judyta Jankowska-Szmul ◽  
Edward Wylegala
Keyword(s):  
Anterior Segment ◽  
Early Postoperative Period ◽  
Swept Source ◽  
Pixel Intensity ◽  
Site Characteristics ◽  
Successful Group ◽  
Grading Scale ◽  
One Year ◽  
Clinical Grading

Purpose. We combined a clinical grading scale and swept source anterior segment OCT to describe the successful and failed CLASS. Material and Methods. 23 patients in the successful group and 17 patients in the failed group were compared in terms of the IBAGS grades and AS-OCT findings at one, three, and twelve months postoperatively. Results. The majority in the successful group presented shallow blebs (91%, 57%, and 52% at 1M, 3M, and 12M, resp.). 59% of the failed group presented no bleb (H0 E0) from the early postoperative period with the rate increasing to 88% at 3M and 100% at 12M. The scleral lake was detected in all the successful patients. The successful group showed significantly higher rates of TDM integrity (P<0.001), IF (P<0.001), and SCF (P<0.05), but there were no significant differences in the rates of microcysts between the groups (P>0.05). We found a significant decrease in the SL anteroposterior extent (P=0.003) and SL height (P<0.001) over time, with no significant correlation between the above parameters and IOP. Conclusions. The subconjunctival bleb may be a sign of the successful CLASS when it matches the AS-OCT findings of TDM integrity, maintained scleral lake, and intrascleral fluid. A validated OCT pixel intensity measurement is required to evaluate the bleb reflectivity.

scholarly journals Clinical Grading scales in intracerebral haemorrhage

2011 ◽  
Vol 2 (1S) ◽  
pp. 69
Author(s):  
Mario Di Napoli
Keyword(s):  
Intracerebral Haemorrhage ◽  
Treatment Options ◽  
Prognostic Models ◽  
Limited Impact ◽  
Treatment Regimens ◽  
Grading Scale ◽  
Ich Score ◽  
Grading Scales ◽  
Clinical Grading

Intracerebral haemorrhage (ICH) represents a subtype of stroke with a higher risk of long-term disability and mortality than any other form of stroke. Despite greater understanding of ICH pathophysiology, treatment options for this devastating condition remain limited. A lack of a standard, universally accepted clinical grading scale for ICH has contributed to reduce availability of optimised treatment regimens, and designing effective clinical trials protocols reducing communication among physicians. A number of ICH grading scales and prognostic models have been developed for mortality and/or functional outcome, particularly 30 days after ICH onset. Several reliable scales have been externally validated in heterogeneous populations. Presently, the ICH score developed by Hemphill and colleagues has showed a greater diffusion due to a good sensibility, specificity and reproducibility together with an easy use. The actual modified versions of this scale have shown only a limited impact on prediction although it is possible to improve prediction of this scale introducing new selected biomarkers. Before an extensive use of these prognostic scale in clinical practice, expansive, prospective, multi-center clinical outcome studies are mandatory to clearly define all aspects of ICH, establish ideal grading scales, and standardised management protocols to enable the identification of novel and effective therapies in ICH.

Abstract P428: The Intracerebral Hemorrhage Score Overestimates Mortality in Young Adults

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jason Maljaars ◽  
Aayushi Garg ◽  
Vaelan Molian ◽  
Enrique C Leira ◽  
Harold P Adams ◽  
...  
Keyword(s):  
Young Adults ◽  
Intracerebral Hemorrhage ◽  
Scoring System ◽  
Mortality Rates ◽  
Early Mortality ◽  
Actual Mortality ◽  
Prediction Of Mortality ◽  
Specific Mortality ◽  
Ich Score ◽  
The Individual

Introduction: The intracerebral hemorrhage (ICH) score is a widely used scoring system for predicting mortality in patients with ICH. This score has been validated for use in adults of all ages with ICH, but not specifically for use in populations of young adults (age 18-45). We aimed to determine the validity of the ICH score when applied to young adults with ICH. Methods: This was a retrospective analysis of all patients aged 18-45 with spontaneous ICH consecutively admitted to our institution from 2009-2019. We calculated the ICH score for each patient, recording the individual subcomponents, and analyzed the scores for prediction of mortality at 30 days. We also analyzed the individual subcomponents of the score for effect on mortality. Results: We identified 156 patients (mean age 35 +/- 7.8; 67 were female, 103 were white) to include in our study. The 30-day mortality rate was 15% (n=24); these patients had a mean age of 34.9 +/- 7.8, compared to survivors who had mean age 35.4 +/- 7.8 (p=0.797). ICH scores were predictive of mortality (p=0.036 for trend); however, the actual mortality rates in our population were substantially lower than those predicted by the ICH score. Specifically, patients in our population with scores of 1, 2, or 3 had 30-day mortality rates of 0%, 3%, and 41%, compared to the current ICH score mortality predictions of 13%, 26%, and 72%, respectively. Scores of 4 and 5 in our population were more closely aligned to current ICH predictions (85% and 100% compared to 97% and 100%, respectively). Of the ICH score subcomponents, ICH volume >30mL (p=0.007) and Glasgow Coma Scale (GCS) scores of 3 or 4 (p=0.014) were the strongest predictors of mortality at 30 days. Conclusion: The ICH score is predictive of mortality for adults of all ages, but the specific mortality rates associated with this scoring system vary considerably when applied to young adults (age 18-45). This over-estimation should be taken into consideration when applying the predictions of the ICH score to young adults with ICH; additionally, special attention should be given to ICH volume >30mL and very low GCS scores, as these were the strongest predictors of early mortality.

scholarly journals Renal function is associated with one-month and one-year mortality in patients with intracerebral hemorrhage

2021 ◽  
Author(s):  
I-Kuan Wang ◽  
Tzung-Hai Yen ◽  
Chon-Haw Tsai ◽  
Yu Sun ◽  
Wei-Lun Chang ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Intracerebral Hemorrhage ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Mortality Rates ◽  
Short Term ◽  
Stroke Registry ◽  
Mortality Risks ◽  
One Year

Background: This study evaluated short-term (1-month) and long-term (1-year) mortality risks associated with kidney function measured by estimated glomerular filtration rate (eGFR) levels at admission for patients with intracerebral hemorrhage. Methods: From the Taiwan Stroke Registry data, we identified and stratified patients with intracerebral hemorrhage into 5 subgroups by the eGFR levels at admission: ≥ 90, 60-89, 30-59, 15-29, and < 15 mL/min/1.73m2 or on dialysis from April 2006 to December 2016. Risks of 1-month mortality and 1-year mortality rates after intracerebral hemorrhage were investigated by the eGFR levels. Results: Both the 1-month mortality and 1-year mortality rates increased as the eGFR level decreased. The 1-month mortality rate was over 5-fold greater in patients with eGFR < 15 mL/min/1.73m2 or on dialysis than in patients with eGFR levels ≥ 90 mL/min/1.73m2 (8.31 versus 1.50 per 1000 person-days), with an adjusted hazard ratio (HR) of 4.59 [95% confidence interval (CI) = 2.71-7.78]. Similarly, the 1-year mortality rate was 7.5-fold greater in patients with eGFR < 15 mL/min/1.73m2 or on dialysis than in patients with eGFR ≥ 90 mL/min/1.73m2, with an adjusted HR of 4.54 (95% CI 2.95-6.98). Conclusion: The eGFR level can be an indicator of prognosis for patients with intracerebral hemorrhage.

scholarly journals Clinical Grading scales in intracerebral haemorrhage

2011 ◽  
Vol 2 (1S) ◽  
pp. 69-76 ◽  
Author(s):  
Mario Di Napoli
Keyword(s):  
Intracerebral Haemorrhage ◽  
Treatment Options ◽  
Prognostic Models ◽  
Limited Impact ◽  
Treatment Regimens ◽  
Grading Scale ◽  
Ich Score ◽  
Grading Scales ◽  
Clinical Grading

Intracerebral haemorrhage (ICH) represents a subtype of stroke with a higher risk of long-term disability and mortality than any other form of stroke. Despite greater understanding of ICH pathophysiology, treatment options for this devastating condition remain limited. A lack of a standard, universally accepted clinical grading scale for ICH has contributed to reduce availability of optimised treatment regimens, and designing effective clinical trials protocols reducing communication among physicians. A number of ICH grading scales and prognostic models have been developed for mortality and/or functional outcome, particularly 30 days after ICH onset. Several reliable scales have been externally validated in heterogeneous populations. Presently, the ICH score developed by Hemphill and colleagues has showed a greater diffusion due to a good sensibility, specificity and reproducibility together with an easy use. The actual modified versions of this scale have shown only a limited impact on prediction although it is possible to improve prediction of this scale introducing new selected biomarkers. Before an extensive use of these prognostic scale in clinical practice, expansive, prospective, multi-center clinical outcome studies are mandatory to clearly define all aspects of ICH, establish ideal grading scales, and standardised management protocols to enable the identification of novel and effective therapies in ICH.

scholarly journals Correlation between Intracerebral Hemorrhage Score and surgical outcome of spontaneous intracerebral hemorrhage

2013 ◽  
Vol 39 (1) ◽  
pp. 1-5 ◽  
Author(s):  
HU Rashid ◽  
R Amin ◽  
A Rahman ◽  
MR Islam ◽  
M Hossain ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Surgical Outcome ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Treatment Protocols ◽  
Face To Face ◽  
Set Inclusion ◽  
Grading Scale ◽  
Ich Score ◽  
Medical University ◽  
Structured Questionnaire

Spontaneous intracerebral hemorrhage (ICH) comprises 10-15% of all strokes and has a higher risk of morbidity and mortality (40-45%). A simple and widely valid clinical grading scale, the Intracerebral Hemorrhage Score (ICH score) was developed to predict to outcome of spontaneous ICH. The aim of the present study was to assess the relation between the ICH score and the surgical outcome of ICH by Glasgow Outcome Scale (GOS) at the 30th post ictus day in our perspective. This prospective study was done during the period of April 2009 to October 2010 in Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Forty three cases were enrolled by set inclusion and exclusion criteria. Intracerebral Hemorrhage Score was calculated during admission and the surgical outcome of ICH was determined by GOS by face to face or telephone interview using structured questionnaire on their 30th post ictus day. Correlation between the ICH score and the surgical outcome of ICH was done by Pearson’s correlation coefficient test. Value of r was found to be -0.635 which was statistically highly significant (p=.001) and the relation was found to be negative. Higher ICH score had unfavorable outcome. As correlation between the ICH score and the surgical outcome of ICH was found statistically highly significant, it can be used widely as a grading scale in preoperative counseling. The use of ICH score could improve standardization of clinical treatment protocols and clinical research studies in ICH. Bangladesh Med Res Counc Bull 2013; 39: 1-5

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