Maas Matthew B, Francis Brandon A, Sangha Rajbeer S, Lizza Bryan D, Liotta Eric M, Naidech Andrew M
Department of Neurology, Northwestern University, Chicago, IL, USA.
Cerebrovasc Dis. 2017;43(3-4):110-116. doi: 10.1159/000452679. Epub 2017 Jan 4.
Prognostic assessments, which are crucial for decision-making in critical illnesses, have shown unsatisfactory reliability. We compared the accuracy of a widely used prognostic score against a model derived from clinical data obtained 5 days after admission for patients with intracerebral hemorrhage (ICH), a condition for which prognostication has proven notoriously challenging and prone to bias.
Patients enrolled in a prospective observational cohort study of spontaneous ICH underwent hourly Glasgow Coma Scale (GCS) assessment. Outcome was measured at 3 months using the modified Rankin Scale (mRS). We analyzed the change in correlation between GCS and 3-month mRS scores from admission through day 5, and compared the performance of a parsimonious set of day 5 clinical variables against the ICH score.
Data was collected on 254 subjects. The ICH score and day 5 GCS score were both correlated with 3-month mRS score (p < 0.001), but the correlation was stronger with day 5 GCS score (p < 0.05 by Fisher z-transformation). Premorbid mRS score, intraventricular hemorrhage and day 5 GCS score were independent predictors of outcome (all p < 0.05 in ordinal regression model). While ICH score correctly classified good (mRS 0-3) vs. poor (mRS 4-6) outcome in 73% of cases, the day 5 model correctly classified 83% of cases.
A simple reassessment after 5 days of care significantly improves the accuracy of prognosticating outcome in patients with ICH. These data confirm the feasibility and potential utility of early reassessments in refining prognosis for patients who survive early stabilization of a severe neurologic injury.
预后评估对危重病的决策至关重要，但已显示出可靠性不尽人意。我们将一种广泛使用的预后评分的准确性与从脑出血（ICH）患者入院5天后获得的临床数据推导的模型进行了比较，脑出血的预后评估极具挑战性且容易出现偏差。
纳入自发性脑出血前瞻性观察队列研究的患者每小时进行格拉斯哥昏迷量表（GCS）评估。使用改良Rankin量表（mRS）在3个月时测量结局。我们分析了从入院到第5天GCS与3个月mRS评分之间相关性的变化，并将一组简洁的第5天临床变量的表现与ICH评分进行了比较。
收集了254名受试者的数据。ICH评分和第5天GCS评分均与3个月mRS评分相关（p < 0.001），但与第5天GCS评分的相关性更强（通过Fisher z变换，p < 0.05）。病前mRS评分、脑室内出血和第5天GCS评分是结局的独立预测因素（在有序回归模型中均p < 0.05）。虽然ICH评分在73%的病例中正确分类了良好（mRS 0-3）与不良（mRS 4-6）结局，但第5天模型正确分类了83%的病例。
护理5天后进行简单的重新评估可显著提高脑出血患者预后评估的准确性。这些数据证实了早期重新评估在完善严重神经损伤早期稳定存活患者预后方面的可行性和潜在效用。
