Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599-7025, USA.
Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA.
Neurocrit Care. 2024 Apr;40(2):395-414. doi: 10.1007/s12028-023-01854-7. Epub 2023 Nov 3.
The objective of this document is to provide recommendations on the formal reliability of major clinical predictors often associated with intracerebral hemorrhage (ICH) neuroprognostication.
A narrative systematic review was completed using the Grading of Recommendations Assessment, Development, and Evaluation methodology and the Population, Intervention, Comparator, Outcome, Timing, Setting questions. Predictors, which included both individual clinical variables and prediction models, were selected based on clinical relevance and attention in the literature. Following construction of the evidence profile and summary of findings, recommendations were based on Grading of Recommendations Assessment, Development, and Evaluation criteria. Good practice statements addressed essential principles of neuroprognostication that could not be framed in the Population, Intervention, Comparator, Outcome, Timing, Setting format.
Six candidate clinical variables and two clinical grading scales (the original ICH score and maximally treated ICH score) were selected for recommendation creation. A total of 347 articles out of 10,751 articles screened met our eligibility criteria. Consensus statements of good practice included deferring neuroprognostication-aside from the most clinically devastated patients-for at least the first 48-72 h of intensive care unit admission; understanding what outcomes would have been most valued by the patient; and counseling of patients and surrogates whose ultimate neurological recovery may occur over a variable period of time. Although many clinical variables and grading scales are associated with ICH poor outcome, no clinical variable alone or sole clinical grading scale was suggested by the panel as currently being reliable by itself for use in counseling patients with ICH and their surrogates, regarding functional outcome at 3 months and beyond or 30-day mortality.
These guidelines provide recommendations on the formal reliability of predictors of poor outcome in the context of counseling patients with ICH and surrogates and suggest broad principles of neuroprognostication. Clinicians formulating their judgments of prognosis for patients with ICH should avoid anchoring bias based solely on any one clinical variable or published clinical grading scale.
本文旨在为与颅内出血（ICH）神经预后相关的主要临床预测因素的正式可靠性提供建议。
使用推荐评估、制定和评估（Grading of Recommendations Assessment, Development, and Evaluation，GRADE）方法和人群、干预、比较、结局、时间、地点问题进行叙述性系统综述。预测因子包括个体临床变量和预测模型，根据文献中的临床相关性和关注度进行选择。在构建证据概况和总结发现后，根据 GRADE 标准提出建议。良好实践声明涉及神经预后的基本原则，这些原则无法按照人群、干预、比较、结局、时间、地点的格式制定。
选择了六个候选临床变量和两个临床分级量表（原始 ICH 评分和最大治疗 ICH 评分）来制定推荐意见。从筛选的 10751 篇文章中，共筛选出 347 篇符合纳入标准的文章。良好实践的共识声明包括在 ICU 入院至少 48-72 小时内推迟神经预后评估，除非患者病情最严重；了解患者最看重的结局是什么；以及对那些最终可能在不同时间段恢复神经功能的患者及其代理人进行咨询。尽管许多临床变量和分级量表与 ICH 不良结局相关，但专家组认为，目前没有单一的临床变量或单独的临床分级量表本身可以用于为 ICH 患者及其代理人提供咨询，以了解 3 个月及以后的功能结局或 30 天死亡率。
这些指南提供了有关 ICH 患者及其代理人咨询中不良结局预测因素正式可靠性的建议，并提出了神经预后的广泛原则。制定 ICH 患者预后判断的临床医生应避免仅基于任何一个临床变量或发表的临床分级量表来产生锚定偏差。
