荷兰对二次颅内出血评分的外部验证。
External validation of the secondary intracerebral hemorrhage score in The Netherlands.
机构信息
From the Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (C.J.J.v.A., G.J.E.R., A.A., C.J.M.K.), Department of Radiology (B.K.V.), Julius Center for Health Sciences and Primary Care (J.P.G., A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands (P.J.v.L.).
出版信息
Stroke. 2013 Oct;44(10):2904-6. doi: 10.1161/STROKEAHA.113.002386. Epub 2013 Aug 6.
BACKGROUND AND PURPOSE
We aimed to validate externally in a setting outside the United States the secondary intracerebral hemorrhage (ICH) score that was developed to predict the probability of macrovascular causes in patients with nontraumatic ICH.
METHODS
Patients with nontraumatic ICH admitted to the University Medical Center Utrecht, the Netherlands, between 2003 and 2011 were included if an angiographic examination, neurosurgical inspection, or pathological examination had been performed. Secondary ICH score performance was assessed by calibration (agreement between predicted and observed outcomes) and discrimination (separation of those with and without macrovascular cause).
RESULTS
Forty-eight of 204 patients (23.5%) had a macrovascular cause. The secondary ICH score showed modest calibration (P=0.06) and modest discriminative ability (c-statistic 0.73; 95% confidence interval, 0.65-0.80). Discrimination improved slightly using only noncontrast computed tomography categorization (c-statistic 0.79; 95% confidence interval, 0.72-0.86).
CONCLUSIONS
The discriminative ability and calibration of the secondary ICH score are moderate in a university hospital setting outside the United States. Clues on noncontrast computed tomography are the strongest predictor of a macrovascular cause in patients with ICH.
背景与目的
我们旨在对在美国以外的环境中对开发的二级脑出血（ICH）评分进行外部验证，该评分旨在预测非创伤性 ICH 患者发生大血管原因的可能性。
方法
如果对患者进行了血管造影检查、神经外科检查或病理检查，那么荷兰乌得勒支大学医学中心在 2003 年至 2011 年间收治的非创伤性 ICH 患者即可纳入研究。通过校准（预测结果与观察结果之间的一致性）和区分（有和无大血管原因的患者之间的区分）来评估二级 ICH 评分的表现。
结果
204 名患者中有 48 名（23.5%）存在大血管原因。二级 ICH 评分显示出适度的校准（P=0.06）和适度的区分能力（c 统计量为 0.73；95%置信区间，0.65-0.80）。仅使用非对比 CT 分类，区分能力略有提高（c 统计量为 0.79；95%置信区间，0.72-0.86）。
结论
在美国以外的大学医院环境中，二级 ICH 评分的区分能力和校准适度。非对比 CT 上的线索是 ICH 患者发生大血管原因的最强预测因素。
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