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Comparison of all 19 published prognostic scores for intracerebral hemorrhage.

Journal article
Authors Jarno Satopää
Satu Mustanoja
Atte Meretoja
Jukka Putaala
Markku Kaste
Mika Niemelä
Turgut Tatlisumak
Daniel Strbian
Published in Journal of the neurological sciences
Volume 379
Pages 103-108
ISSN 1878-5883
Publication year 2017
Published at Institute of Neuroscience and Physiology
Pages 103-108
Language en
Links dx.doi.org/10.1016/j.jns.2017.05.03...
www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords Cerebral Hemorrhage, diagnosis, mortality, Female, Hospital Mortality, trends, Humans, Male, Prognosis, Retrospective Studies, Risk Factors, Severity of Illness Index
Subject categories Neurology

Abstract

We evaluated the accuracy of 19 published prognostic scores to find the best tool for predicting mortality after intracerebral hemorrhage (ICH).A retrospective single-center analysis of consecutive patients with ICH (n=1013). After excluding patients with missing data (n=131), we analyzed 882 patients for 3-month (primary outcome), in-hospital, and 12-month mortality. We analyzed the strength of the individual score components and calculated the c-statistics, Youden index, sensitivity, specificity, negative and positive predictive value (NPV and PPV) for the scores. Finally, we included every score component in a multivariable model to analyze the maximum predictive value of the data elements combined.Observed in-hospital mortality was 23.6%, 3-month mortality was 31.0%, and 12-month mortality was 35.3%. For in-hospital mortality, the National Institutes of Health Stroke Scale (NIHSS) performed equally good as the best score for the other outcomes, the ICH Functional Outcome Score (ICH-FOS). The c-statistics of the scores varied from 0.6293 (95% CI 0.587-0.672) to 0.8802 (0.855-0.906). With all variables from all the scores in a multivariable regression model, the c-statistics did not improve, being 0.89 (0.867-0.913). Using the Youden index cutoff for the ICH-FOS score, the sensitivity (73%), specificity (90%), PPV (76%), and NPV (88%) for the primary outcome were good.A plethora of scores exists to help clinicians estimate the prognosis of an acute ICH patient. The NIHSS can be used to quantify the risk of in-hospital death while the ICH-FOS performed best for the other outcomes.

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