Nisar Taha, Alchaki Abdul, Hillen Machteld
Rutgers New Jersey Medical School, Newark, NJ, United States.
Rutgers New Jersey Medical School, Newark, NJ, United States.
Clin Neurol Neurosurg. 2018 Nov;174:36-39. doi: 10.1016/j.clineuro.2018.09.007. Epub 2018 Sep 5.
Hemorrhagic stroke cause around 10-20% of all strokes. ICH (Intracerebral Hemorrhage) score is a grading scale used to determine survival outcome after nontraumatic ICH at 30 days. It is a 6-point scale based on 5 independent variables, which are graded based on the weight of their association. These 5 variables are the Glasgow coma scale (GCS), ICH Volume, Intraventricular hemorrhage (IVH), Infratentorial origin and age. The aim of our study is to validate the ICH score in our population.
We conducted a retrospective chart review of 245 adult patients who presented with acute ICH to University Hospital, Newark between 1/1/2012 to 12/30/2015. GCS recorded in Emergency Department was used. Initial Computed tomography (CT) Head was used for calculating volume, IVH, and location origin, while ICH Volume was calculated using the ABC/2 method. The primary outcome was 30-day mortality. Patients with a hemorrhagic transformation of ischemic strokes or traumatic ICH were excluded.
245 patients met our inclusion criteria. 30-day mortality was 36%. ICH scores ranged from 0 to 5, and an increase in the ICH score was associated with an increase in 30-day mortality. 4 variables in the ICH score had a significant association with 30-day mortality: ICH Volume ≥30 ml (OR, 17.24; 95% CI, 8.33-35.66; P < 0.001), IVH (OR, 6.91; 95% CI, 3.72-12.85; P < 0.001), low GCS (P < 0.001) and infratentorial origin of bleed significant (OR, 2.17; 95% CI, 1.07-4.40; P 0.039). However, the association of age ≥ 80 years with respect to 30-day mortality wasn't statistically significant in our group (OR, 1.49; 95% CI, 0.70-3.17; P 0.325).
Our study is one of the largest done at a single urban center to validate the ICH score. Age ≥ 80 years wasn't statistically significant with respect to 30-day mortality in our group. Restratification of the weight of individual variable in the ICH equation with modification of the ICH score can potentially more accurately establish mortality risk. Nevertheless, the overall prediction of mortality was accurate and reproducible in our study.
出血性卒中约占所有卒中的10%-20%。脑出血（ICH）评分是一种用于确定非创伤性脑出血30天时生存结局的分级量表。它是一个基于5个独立变量的6分制量表，这些变量根据其关联权重进行分级。这5个变量分别是格拉斯哥昏迷量表（GCS）、脑出血体积、脑室内出血（IVH）、幕下起源和年龄。我们研究的目的是在我们的人群中验证ICH评分。
我们对2012年1月1日至2015年12月30日期间在纽瓦克大学医院就诊的245例急性脑出血成年患者进行了回顾性病历审查。使用急诊科记录的GCS。最初的头颅计算机断层扫描（CT）用于计算体积、IVH和出血部位起源，而脑出血体积使用ABC/2方法计算。主要结局是30天死亡率。排除缺血性卒中出血转化或创伤性脑出血患者。
245例患者符合我们的纳入标准。30天死亡率为36%。ICH评分范围为0至5分，ICH评分的增加与30天死亡率的增加相关。ICH评分中的4个变量与30天死亡率有显著关联：脑出血体积≥30 ml（OR=17.24；95%CI：8.33-35.66；P<0.001）、IVH（OR=6.91；95%CI：3.72-12.85；P<0.001）、低GCS（P<0.001）和幕下出血起源显著（OR=2.17；95%CI：1.07-4.40；P=0.039）。然而，在我们的研究组中，年龄≥80岁与30天死亡率的关联无统计学意义（OR=1.49；95%CI：0.70-3.17；P=0.325）。
我们的研究是在单个城市中心进行的最大规模的验证ICH评分的研究之一。在我们的研究组中，年龄≥80岁与30天死亡率无统计学意义。通过修改ICH评分对ICH方程中各个变量的权重进行重新分级可能会更准确地确定死亡风险。尽管如此，在我们的研究中，死亡率的总体预测是准确且可重复的。
