STUDY OF  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 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

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.

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.

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

scholarly journals Prognostication after intracerebral hemorrhage: a review

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Jens Witsch ◽  
Bob Siegerink ◽  
Christian H. Nolte ◽  
Maximilian Sprügel ◽  
Thorsten Steiner ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Intracerebral Hemorrhage ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Prognostic Scores ◽  
Predictor Variables ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Net Benefit ◽  
Patient Reported ◽  
Ich Score

Abstract Background Approximately half of patients with spontaneous intracerebral hemorrhage (ICH) die within 1 year. Prognostication in this context is of great importance, to guide goals of care discussions, clinical decision-making, and risk stratification. However, available prognostic scores are hardly used in clinical practice. The purpose of this review article is to identify existing outcome prediction scores for spontaneous intracerebral hemorrhage (ICH) discuss their shortcomings, and to suggest how to create and validate more useful scores. Main text Through a literature review this article identifies existing ICH outcome prediction models. Using the Essen-ICH-score as an example, we demonstrate a complete score validation including discrimination, calibration and net benefit calculations. Score performance is illustrated in the Erlangen UKER-ICH-cohort (NCT03183167). We identified 19 prediction scores, half of which used mortality as endpoint, the remainder used disability, typically the dichotomized modified Rankin score assessed at variable time points after the index ICH. Complete score validation by our criteria was only available for the max-ICH score. Our validation of the Essen-ICH-score regarding prediction of unfavorable outcome showed good discrimination (area under the curve 0.87), fair calibration (calibration intercept 1.0, slope 0.84), and an overall net benefit of using the score as a decision tool. We discuss methodological pitfalls of prediction scores, e.g. the withdrawal of care (WOC) bias, physiological predictor variables that are often neglected by authors of clinical scores, and incomplete score validation. Future scores need to integrate new predictor variables, patient-reported outcome measures, and reduce the WOC bias. Validation needs to be standardized and thorough. Lastly, we discuss the integration of current ICH scoring systems in clinical practice with the awareness of their shortcomings. Conclusion Presently available prognostic scores for ICH do not fulfill essential quality standards. Novel prognostic scores need to be developed to inform the design of research studies and improve clinical care in patients with ICH.

scholarly journals Braden Scale for Assessing Pneumonia After Acute Ischemic Stroke

2019 ◽  
Author(s):  
Yunlong Ding ◽  
Yazhou Yan ◽  
Jiali Niu ◽  
Yanrong Zhang ◽  
Zhiqun Gu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Area Under The Curve ◽  
National Institutes Of Health ◽  
Receiver Operating Curve ◽  
Stroke Outcomes ◽  
Braden Scale ◽  
Grading Scale ◽  
The Mean ◽  
Clinical Grading

Abstract Background Prevention of pneumonia is critical for patients with acute ischemic stroke (AIS). The six indexes in the Braden Scale seemsto be related to the occurrence of pneumonia. We aimed to evaluate the feasibility of the Braden Scale in predicting the occurrence of pneumonia after AIS. Methods We studied a series of consecutive patients with AIS who were admitted to hospital. The cohort was subdivided into pneumonia group and no pneumonia group. The score of the Braden Scale, demographic and clinical characteristics at admission were obtained and analyzed by statistical comparisons between two groups. We investigated the predictive validity of the Braden scale by Receiver operating curve (ROC). Results 414 patients with AIS were included in this study. 57 of 414 (13.8%) patients fulfilled the criteria for post-stroke pneumonia. The National Institutes of Health Stroke Scale (NIHSS) score in the pneumonia group was significantly higher than in the no pneumonia group (P < 0.01). The mean score of the Braden Scale in the pneumonia group was significantly lower than that in the no pneumonia group (P < 0.01). The six subscales of the Braden Scale between the two groups all had significant differences. The area under the curve (AUC) for the Braden scale predicting pneumonia after acute ischemic was 0.883 (95% CI = 0.828-0.937). And with 18 points as the demarcation score, the sensitivity was 83.2% and the specificity was 84.2%. Conclusion The Braden Scale with 18 points as the demarcation score is a valid clinical grading scale for predicting pneumonia after AIS at presentation. Further studies on effect of Braden Scale on stroke outcomes are needed.

Intracerebral Hemorrhage-Score Allows a Reliable Prediction of Mortality in Patients with Spontaneous Intracerebral Hemorrhage Managed by Fibrinolytic Therapy

2019 ◽  
Vol 48 (3-6) ◽  
pp. 165-170
Author(s):  
Vesna Malinova ◽  
Bogdan Iliev ◽  
Dorothee Mielke ◽  
Veit Rohde
Keyword(s):  
Mortality Rate ◽  
Intracerebral Hemorrhage ◽  
Fibrinolytic Therapy ◽  
Clot Lysis ◽  
High Morbidity ◽  
Hematoma Volume ◽  
Chi Square ◽  
Prediction Of Mortality ◽  
Chi Square Test ◽  
Ich Score

Objective: Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Prognosis estimation would be helpful for the treatment decision making in ICH patients. The ICH-score was published in 2001 to estimate the 30-day mortality in conservatively treated patients with ICH. We evaluated the reproducibility of the ICH-score in ICH patients undergoing fibrinolytic therapy. Methods: We performed a retrospective analysis of patients with supratentorial ICH managed by fibrinolytic therapy and evaluated the 30-day mortality. The ICH-score was then applied to match the mortality in our patients with the mortality predicted by the ICH-score. The ICH-score is based on parameters available at admission: age, hematoma volume, intraventricular expansion, and clinical status according to the Glasgow Coma Scale. Results: A total of 233 patients were analyzed. The 30-day mortality rate was 30% (70/233). An age of ≥80 years was associated with a significantly higher mortality rate (OR 2.26, chi-square test p = 0.01). A hematoma volume of ≥30 mL led significantly more often to 30-day mortality (OR 3.72, chi-square test p = 0.01). The mortality was significantly higher in the patients with intraventricular hemorrhage (2.97, chi-square test p = 0.003). The ICH-score showed a significant correlation with mortality (chi-square test, p < 0.0001). The following mortality rates were estimated using the ICH-score in our cohort: 1 = 0% (0/13), 2 = 0% (0/51), 3 = 1.3% (1/82), 4 = 43% (13/31), 5 = 100% (56/56). Conclusion: The ICH-score not only allows a reliable estimation of the 30-day mortality in patients with ICH treated conservatively but also treated by clot lysis. Compared to conservative treatment, the fibrinolytic therapy reduced the 30-day mortality in the patients with ICH-scores 1–4. Patients with ICH-score 5 do not have a benefit of fibrinolytic therapy and should no longer be considered to be candidates for fibrinolytic therapy.

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.

Intracerebral hemorrhage secondary to intravenous and endovascular intraarterial revascularization therapies in acute ischemic stroke: an update on risk factors, predictors, and management

2012 ◽  
Vol 32 (4) ◽  
pp. E2 ◽  
Author(s):  
Maxim Mokin ◽  
Peter Kan ◽  
Tareq Kass-Hout ◽  
Adib A. Abla ◽  
Travis M. Dumont ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Current Knowledge ◽  
Ct Perfusion ◽  
Imaging Techniques ◽  
Treatment Protocols ◽  
Systemic Thrombolysis ◽  
Revascularization Therapy

Intracerebral hemorrhage (ICH) secondary to intravenous and intraarterial revascularization strategies for emergent treatment of acute ischemic stroke is associated with high mortality. ICH from systemic thrombolysis typically occurs within the first 24–36 hours of treatment initiation and is characterized by rapid hematoma development and growth. Pathophysiological mechanisms of revascularization therapy-induced ICH are complex and involve a combination of several distinct processes, including the direct effect of thrombolytic agents, disruption of the blood-brain barrier secondary to ischemia, and direct vessel damage from wire and microcatheter manipulations during endovascular procedures. Several definitions of ICH secondary to thrombolysis currently exist, depending on clinical or radiological characteristics used. Multiple studies have investigated clinical and laboratory risk factors associated with higher rates of ICH in this setting. Early ischemic changes seen on noncontrast CT scanning are strongly associated with higher rates of hemorrhage. Modern imaging techniques, particularly CT perfusion, provide rapid assessment of hemodynamic parameters of the brain. Specific patterns of CT perfusion maps can help identify patients who are likely to benefit from revascularization or to develop hemorrhagic complications. There are no established guidelines that describe management of revascularization therapy–induced ICH, and great variability in treatment protocols currently exist. General principles that apply to the management of spontaneous ICH might not be as effective for revascularization therapy–induced ICH. In this article, the authors review current knowledge of risk factors and radiological predictors of ICH secondary to stroke revascularization techniques and analyze medical and surgical management strategies for ICH in this setting.

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.

Sign in / Sign up

Export Citation Format

Share Document