Faigle Roland, Chen Bridget J, Krieger Rachel, Marsh Elisabeth B, Alkhachroum Ayham, Xiong Wei, Urrutia Victor C, Gottesman Rebecca F
From the Department of Neurology (R.F., B.J.C., R.K., E.B.M., V.C.U., R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (A.A.), University of Miami, Miller School of Medicine, Jackson Memorial Health System, FL; and Department of Neurology (W.X.), Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, OH.
Neurology. 2021 May 18;96(20):e2458-e2468. doi: 10.1212/WNL.0000000000011927. Epub 2021 Mar 31.
To develop a risk prediction score identifying patients with intracerebral hemorrhage (ICH) at low risk for critical care.
We retrospectively analyzed data of 451 patients with ICH between 2010 and 2018. The sample was randomly divided into a development and a validation cohort. Logistic regression was used to develop a risk score by weighting independent predictors of intensive care unit (ICU) needs according to strength of association. The risk score was tested in the validation cohort and externally validated in a dataset from another institution.
The rate of ICU interventions was 80.3%. Systolic blood pressure (SBP), Glasgow Coma Scale (GCS) score, intraventricular hemorrhage (IVH), and ICH volume were independent predictors of critical care, resulting in the following point assignments for the Intensive Care Triaging in Spontaneous Intracerebral Hemorrhage (INTRINSIC) score: SBP 160 to 190 mm Hg (1 point), SBP >190 mm Hg (3 points); GCS 8 to 13 (1 point), GCS <8 (3 points); ICH volume 16 to 40 cm (1 point), ICH volume >40 cm (2 points); and presence of IVH (1 point), with values ranging between 0 and 9. Among patients with a score of 0 and no ICU needs during their emergency department stay, 93.6% remained without critical care needs. In an external validation cohort of patients with ICH, the INTRINSIC score achieved an area under the receiver operating characteristic curve of 0.823 (95% confidence interval 0.782-0.863). A score <2 predicted the absence of critical care needs with 48.5% sensitivity and 88.5% specificity, and a score <3 predicted the absence of critical care needs with 61.7% sensitivity and 83.0% specificity.
The INTRINSIC score identifies patients with ICH who are at low risk for critical care interventions.
This study provides Class II evidence that the INTRINSIC score identifies patients with ICH at low risk for critical care interventions.
制定一种风险预测评分，以识别重症监护低风险的脑出血（ICH）患者。
我们回顾性分析了2010年至2018年间451例ICH患者的数据。样本被随机分为一个开发队列和一个验证队列。采用逻辑回归，根据关联强度对重症监护病房（ICU）需求的独立预测因素进行加权，以制定风险评分。在验证队列中对风险评分进行测试，并在来自另一家机构的数据集中进行外部验证。
ICU干预率为80.3%。收缩压（SBP）、格拉斯哥昏迷量表（GCS）评分、脑室内出血（IVH）和ICH体积是重症监护的独立预测因素，由此得出自发性脑出血重症监护分诊（INTRINSIC）评分的以下分值分配：SBP 160至190 mmHg（1分），SBP>190 mmHg（3分）；GCS 8至13（1分），GCS<8（3分）；ICH体积16至40 cm（1分），ICH体积>40 cm（2分）；以及存在IVH（1分），分值范围为0至9分。在急诊科就诊期间评分为0且无ICU需求的患者中，93.6%仍无重症监护需求。在ICH患者的外部验证队列中，INTRINSIC评分在受试者工作特征曲线下的面积为0.823（95%置信区间0.782 - 0.863）。评分<2预测无重症监护需求的敏感度为48.5%，特异度为88.5%；评分<3预测无重症监护需求的敏感度为61.7%，特异度为83.0%。
INTRINSIC评分可识别出重症监护干预低风险的ICH患者。
本研究提供二级证据表明INTRINSIC评分可识别出重症监护干预低风险的ICH患者。
