Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY 10065, USA.
Neurocrit Care. 2013 Feb;18(1):59-63. doi: 10.1007/s12028-011-9607-7.
A study performed in Hong Kong of catheter angiography after ICH found a high rate of structural lesions in patients 45 years of age or younger, without a history of hypertension, or with lobar hemorrhage. We hypothesized that a clinical decision rule based on these Hong Kong criteria would reliably identify patients who require MRI after ICH.
We identified all patients admitted with ICH to our medical center during a 5-year period who underwent brain MRI. Patients were excluded if the history revealed an obvious cause of ICH. Two study neurologists independently adjudicated whether MRI revealed the cause of ICH. We devised a rule recommending MRI if patients met one or more Hong Kong criteria, and calculated the proportion of patients with diagnostic MRI studies who would have been identified by this rule. We also examined the performance of a modified rule using age ≤ 55 years.
The original Hong Kong rule applied to 102 of the 148 patients in our cohort (69%), and would have recommended MRI in 25 of 27 patients with diagnostic MRI studies (93%, 95% CI 76-99%). The modified rule applied to 110 patients (74%), and would have recommended MRI in all 27 patients with diagnostic MRI studies (100%, 95% CI 91-100%).
A rule based on simple clinical criteria may be useful for stratifying the yield of MRI after ICH. If validated in further studies, such a rule could reduce the number of unnecessary MRI studies after ICH, leading to more cost-effective care.
香港一项关于 ICH 后血管造影的研究发现，45 岁或以下、无高血压史或脑叶出血史的患者存在较高的结构性病变发生率。我们假设，基于这些香港标准的临床决策规则将可靠地识别出需要在 ICH 后进行 MRI 的患者。
我们确定了在 5 年期间因 ICH 入住我们医疗中心的所有患者，这些患者均接受了脑部 MRI 检查。如果病史显示明显的 ICH 原因，则将患者排除在外。两名研究神经科医生独立判断 MRI 是否揭示了 ICH 的原因。我们制定了一个规则，如果患者符合一个或多个香港标准，则推荐进行 MRI，并计算出该规则将识别出的具有诊断性 MRI 研究的患者比例。我们还检查了使用年龄≤55 岁的修改规则的性能。
原始的香港规则适用于我们队列中的 148 名患者中的 102 名（69%），并且会推荐对 27 名具有诊断性 MRI 研究的患者中的 25 名进行 MRI（93%，95%CI76-99%）。修改后的规则适用于 110 名患者（74%），并且会对所有 27 名具有诊断性 MRI 研究的患者推荐 MRI（100%，95%CI91-100%）。
基于简单临床标准的规则可能有助于分层 ICH 后 MRI 的收益。如果在进一步的研究中得到验证，这样的规则可以减少 ICH 后不必要的 MRI 检查数量，从而实现更具成本效益的护理。
