Clinical Grading scales in intracerebral haemorrhage

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.

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

Mediscope ◽

10.3329/mediscope.v5i1.36720 ◽

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

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

Journal of Neurosurgery ◽

10.3171/2019.5.jns19622 ◽

2020 ◽

Vol 133 (3) ◽

pp. 800-807 ◽

Cited By ~ 3

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.

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Considering a Potential Role of Linalool as a Mood Stabilizer for Bipolar Disorder

Current Pharmaceutical Design ◽

10.2174/1381612826666200724160742 ◽

2020 ◽

Vol 26 (40) ◽

pp. 5128-5133

Author(s):

Kate Levenberg ◽

Wade Edris ◽

Martha Levine ◽

Daniel R. George

Keyword(s):

Bipolar Disorder ◽

Treatment Options ◽

Mood Stabilizer ◽

Well Being ◽

Epidemiologic Studies ◽

Treatment Regimens ◽

Bipolar Spectrum Disorders ◽

Short And Long Term

Epidemiologic studies suggest that the lifetime prevalence of bipolar spectrum disorders ranges from 2.8 to 6.5 percent of the population. To decrease morbidity and mortality associated with disease progression, pharmacologic intervention is indicated for the majority of these patients. While a number of effective treatment regimens exist, many conventional medications have significant side effect profiles that adversely impact patients’ short and long-term well-being. It is thus important to continue advancing and improving therapeutic options available to patients. This paper reviews the limitations of current treatments and examines the chemical compound Linalool, an alcohol found in many plant species, that may serve as an effective mood stabilizer. While relatively little is known about Linalool and bipolar disorder, the compound has been shown to have antiepileptic, anti-inflammatory, anxiolytic, anti-depressive, and neurotrophic effects, with mechanisms that are comparable to current bipolar disorder treatment options.

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The Utility of Assessing Neck Acne

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475416673051 ◽

2016 ◽

Vol 21 (1) ◽

pp. 82-83

Author(s):

Karishma Desai ◽

Marc Philip Frey ◽

Jerry Tan

Keyword(s):

Treatment Options ◽

The Body ◽

Essential Component ◽

Posterior Neck ◽

Grading Scale ◽

Lower Neck ◽

Grading Scales ◽

Facial Acne

Background: Acne grading is an essential component in establishing treatment options, but little is known on how neck acne should be incorporated into grading scales. Objective: Our objective was to explore the prevalence of neck acne and determine if its own severity category on an acne global grading scale was warranted. Methods: Acne severity was assessed in 6 categories: face, chest, back, anterior upper (AUN), anterior lower neck (ALN), and posterior neck (PN). Results: The overall prevalence of neck acne was 49%. Of these, 44% had AUN acne, 18.5% had ALN acne, and 19.8% had PN acne. AUN and facial acne had a significant correlation ( r = 0.37, P < .05). No correlation was seen amongst other areas. Males presented with a significantly higher severity of AUN (mean [SD], 1.37 [1.09]) than females (mean [SD], 0.52 [0.91]), on average. Conclusions: While neck acne has proven to be common amongst those with acne on other areas of the body, facial acne can be used as a proxy for classification, as neck severity is usually milder.

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

Journal of Neurosurgery: Case Lessons ◽

10.3171/case2044 ◽

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.

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Predicting long-term outcomes in acute intracerebral haemorrhage using delayed prognostication scores

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000656 ◽

2021 ◽

pp. svn-2020-000656

Author(s):

Ronda Lun ◽

Vignan Yogendrakumar ◽

Tim Ramsay ◽

Michel Shamy ◽

Robert Fahed ◽

...

Keyword(s):

Functional Outcome ◽

Intracerebral Haemorrhage ◽

Functional Outcomes ◽

Predictive Accuracy ◽

Area Under The Curve ◽

Long Term Outcomes ◽

Poor Functional Outcome ◽

Delayed Imaging ◽

Ich Score

ObjectiveThe concept of the ‘self-fulfilling prophecy’ is well established in intracerebral haemorrhage (ICH). The ability to improve prognostication and prediction of long-term outcomes during the first days of hospitalisation is important in guiding conversations around goals of care. We previously demonstrated that incorporating delayed imaging into various prognostication scores for ICH improves the predictive accuracy of 90-day mortality. However, delayed prognostication scores have not been used to predict long-term functional outcomes beyond 90 days.Design, setting and participantsWe analysed data from the ICH Deferoxamine trial to see if delaying the use of prognostication scores to 96 hours after ICH onset will improve performance to predict outcomes at 180 days. 276 patients were included.Interventions and measurementsWe calculated the original ICH score (oICH), modified-ICH score (MICH), max-ICH score and the FUNC score on presentation (baseline), and on day 4 (delayed). Outcomes assessed were mortality and poor functional outcome in survivors (defined as modified Rankin Scale of 4–5) at 180 days. We generated receiver operating characteristic curves, and measured the area under the curve values (AUC) for mortality and functional outcome. We compared baseline and delayed AUCs with non-parametric methods.ResultsAt 180 days, 21 of 276 (7.6%) died. Out of the survivors, 54 of 255 had poor functional outcome (21.2%). The oICH, MICH and max-ICH performed significantly better at predicting 180-day mortality when calculated 4 days later compared with their baseline equivalents ((0.74 vs 0.83, p=0.005), (0.73 vs 0.80, p=0.036), (0.74 vs 0.83, p=0.008), respectively). The delayed calculation of these scores did not significantly improve our accuracy for predicting poor functional outcomes.ConclusionDelaying the calculation of prognostication scores in acute ICH until day 4 improved prediction of 6-month mortality but not functional outcomes.Trial registration numberClinicalTrials.gov Registry (NCT02175225).

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When and in which patients can anticoagulation be resumed after intracerebral haemorrhage?

Reviews in Health Care ◽

10.7175/rhc.3621s115-120 ◽

2011 ◽

Vol 2 (1S) ◽

pp. 115

Author(s):

Marco Marietta ◽

Paola Pedrazzi ◽

Alessandro Ghiddi

Keyword(s):

Atrial Fibrillation ◽

Clinical Trials ◽

Intracerebral Haemorrhage ◽

Heart Valves ◽

Case Reports ◽

Treatment Options ◽

Major Haemorrhage ◽

Mechanical Heart Valves ◽

Antiaggregant Therapy

Whether to resume the anticoagulant or the antiaggregant therapy after an episode of major haemorrhage is a difficult dilemma for the physician. The physician has to take into consideration two major questions: whether the benefits of restarting anticoagulation outweigh the risk, and if so, when and how should anticoagulation be restarted. Although some case reports suggest that anticoagulation can be withheld safely for short periods after ICH, even in patients with mechanical heart valves, it is still not clear if long-term anticoagulation can be safely reinstituted after haemorrhage, for example in patients with atrial fibrillation. In fact, no large and well-conducted randomised clinical trials are available, and there is lack of strong evidence on which guidelines recommendations can be based. The article summarise the available literature findings. Finally, a protocol is suggested which may represent a useful tool for assessing treatment options.

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

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2016.5.11 ◽

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

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When and in which patients can anticoagulation be resumed after intracerebral haemorrhage?

Reviews in Health Care ◽

10.7175/rhc.v2i1s.36 ◽

2011 ◽

Vol 2 (1S) ◽

pp. 115-120

Author(s):

Marco Marietta ◽

Paola Pedrazzi ◽

Alessandro Ghiddi

Keyword(s):

Atrial Fibrillation ◽

Clinical Trials ◽

Intracerebral Haemorrhage ◽

Heart Valves ◽

Case Reports ◽

Treatment Options ◽

Major Haemorrhage ◽

Mechanical Heart Valves ◽

Antiaggregant Therapy

Whether to resume the anticoagulant or the antiaggregant therapy after an episode of major haemorrhage is a difficult dilemma for the physician. The physician has to take into consideration two major questions: whether the benefits of restarting anticoagulation outweigh the risk, and if so, when and how should anticoagulation be restarted. Although some case reports suggest that anticoagulation can be withheld safely for short periods after ICH, even in patients with mechanical heart valves, it is still not clear if long-term anticoagulation can be safely reinstituted after haemorrhage, for example in patients with atrial fibrillation. In fact, no large and well-conducted randomised clinical trials are available, and there is lack of strong evidence on which guidelines recommendations can be based. The article summarise the available literature findings. Finally, a protocol is suggested which may represent a useful tool for assessing treatment options.

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