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Clinical Grading Scales in Intracerebral Hemorrhage

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Abstract

Intracerebral hemorrhage (ICH) carries higher risk of long-term disability and mortality than any other form of stroke. Despite greater understanding of ICH pathophysiology, treatment options for this devastating condition remain limited. Moreover, a lack of a standard, universally accepted clinical grading scale for ICH has contributed to variations in management protocols and clinical trial designs. Grading scales are essential for standardized assessment and communication among physicians, selecting optimized treatment regiments, and designing effective clinical trials. There currently exist a number of ICH grading scales and prognostic models that have been developed for mortality and/or functional outcome, particularly 30 days after the ICH onset. Numerous reliable scales have been externally validated in heterogeneous populations. We extensively reviewed the inherent strengths and limitations of all the existing clinical ICH grading scales based on their development and validation methodology. For all ICH grading scales, we carefully observed study design and the definition and timing of outcome assessment to elucidate inconsistencies in grading scale derivation and application. Ultimately, we call for an expansive, prospective, multi-center clinical outcome study to clearly define all aspects of ICH, establish ideal grading scales, and standardized management protocols to enable the identification of novel and effective therapies in ICH.

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References

  1. Caplan LR. Intracerebral haemorrhage. Lancet. 1992;339:656–8.

    Article  PubMed  CAS  Google Scholar 

  2. Rincon F, Mayer SA. Intracerebral hemorrhage: getting ready for effective treatments. Curr Opin Neurol. 2010;23:59–64.

    Article  PubMed  Google Scholar 

  3. Woo D, Broderick JP. Spontaneous intracerebral hemorrhage: epidemiology and clinical presentation. Neurosurg Clin N Am. 2002;13:265–79, v.

    Google Scholar 

  4. Mayer SA. Ultra-early hemostatic therapy for intracerebral hemorrhage. Stroke. 2003;34:224–9.

    Article  PubMed  Google Scholar 

  5. Broderick JP, Brott T, Tomsick T, Miller R, Huster G. Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg. 1993;78:188–91.

    Article  PubMed  CAS  Google Scholar 

  6. Godoy DA, Pinero G, Di Napoli M. Predicting mortality in spontaneous intracerebral hemorrhage: can modification to original score improve the prediction? Stroke. 2006;37:1038–44.

    Article  PubMed  Google Scholar 

  7. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32:891–7.

    PubMed  Google Scholar 

  8. Ruiz-Sandoval JL, Chiquete E, Romero-Vargas S, Padilla-Martinez JJ, Gonzalez-Cornejo S. Grading scale for prediction of outcome in primary intracerebral hemorrhages. Stroke. 2007;38:1641–4.

    Article  PubMed  Google Scholar 

  9. Chuang YC, Chen YM, Peng SK, Peng SY. Risk stratification for predicting 30-day mortality of intracerebral hemorrhage. Int J Qual Health Care. 2009;21:441–7.

    Article  PubMed  Google Scholar 

  10. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28:14–20.

    Article  PubMed  CAS  Google Scholar 

  11. Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg. 1988;68:985–6.

    Google Scholar 

  12. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–4.

    Article  PubMed  CAS  Google Scholar 

  13. Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986;65:476–83.

    Article  PubMed  CAS  Google Scholar 

  14. Clarke JL, Johnston SC, Farrant M, Bernstein R, Tong D, Hemphill JC 3rd. External validation of the ICH score. Neurocrit Care. 2004;1:53–60.

    Article  PubMed  Google Scholar 

  15. Fernandes H, Gregson BA, Siddique MS, Mendelow AD. Testing the ICH score. Stroke. 2002;33:1455–6 (author reply 1455-1456).

    Article  PubMed  Google Scholar 

  16. Godoy DA, Boccio A. ICH score in a rural village in the Republic of Argentina. Stroke. 2003;34:e150–1 (author reply e150-151).

    Article  PubMed  Google Scholar 

  17. Jamora RD, Kishi-Generao EM Jr, Bitanga ES, Gan RN, Apaga NE, San Jose MC. The ICH score: predicting mortality and functional outcome in an Asian population. Stroke. 2003;34:6–7 (author reply 6-7).

    Article  PubMed  Google Scholar 

  18. Patriota GC, Silva-Junior JM, Barcellos AC, Silva Junior JB, Toledo DO, Pinto FC, Rotta JM. Determining ICH Score: can we go beyond? Arq Neuropsiquiatr. 2009;67:605–8.

    PubMed  Google Scholar 

  19. Weimar C, Benemann J, Diener HC. Development and validation of the Essen Intracerebral Haemorrhage Score. J Neurol Neurosurg Psychiatry. 2006;77:601–5.

    Article  PubMed  CAS  Google Scholar 

  20. Cho DY, Chen CC, Lee WY, Lee HC, Ho LH. A new modified intracerebral hemorrhage score for treatment decisions in basal ganglia hemorrhage—a randomized trial. Crit Care Med. 2008;36:2151–6.

    Article  PubMed  Google Scholar 

  21. Lyden PD, Shuaib A, Lees KR, Davalos A, Davis SM, Diener HC, Grotta JC, Ashwood TJ, Hardemark HG, Svensson HH, et al. Safety and tolerability of NXY-059 for acute intracerebral hemorrhage: the CHANT Trial. Stroke. 2007;38:2262–9.

    Article  PubMed  CAS  Google Scholar 

  22. Naval NS, Mirski MA, Carhuapoma JR. Impact of statins on validation of ICH mortality prediction models. Neurol Res. 2009;31:425–9.

    Article  PubMed  Google Scholar 

  23. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993;24:987–93.

    PubMed  CAS  Google Scholar 

  24. Juvela S. Risk factors for impaired outcome after spontaneous intracerebral hemorrhage. Arch Neurol. 1995;52:1193–200.

    PubMed  CAS  Google Scholar 

  25. Tuhrim S, Dambrosia JM, Price TR, Mohr JP, Wolf PA, Hier DB, Kase CS. Intracerebral hemorrhage: external validation and extension of a model for prediction of 30-day survival. Ann Neurol. 1991;29:658–63.

    Article  PubMed  CAS  Google Scholar 

  26. Hemphill JC 3rd, Farrant M, Neill TA Jr. Prospective validation of the ICH Score for 12-month functional outcome. Neurology. 2009;73:1088–94.

    Article  PubMed  Google Scholar 

  27. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604–7.

    PubMed  Google Scholar 

  28. Jennett B, Snoek J, Bond MR, Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry. 1981;44:285–93.

    Article  PubMed  CAS  Google Scholar 

  29. Cheung RT, Zou LY. Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage. Stroke. 2003;34:1717–22.

    Article  PubMed  Google Scholar 

  30. Weimar C, Roth M, Willig V, Kostopoulos P, Benemann J, Diener HC. Development and validation of a prognostic model to predict recovery following intracerebral hemorrhage. J Neurol. 2006;253:788–93.

    Article  PubMed  Google Scholar 

  31. Kase CS, Furlan AJ, Wechsler LR, Higashida RT, Rowley HA, Hart RG, Molinari GF, Frederick LS, Roberts HC, Gebel JM, et al. Cerebral hemorrhage after intra-arterial thrombolysis for ischemic stroke: the PROACT II trial. Neurology. 2001;57:1603–10.

    PubMed  CAS  Google Scholar 

  32. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.

    Article  PubMed  CAS  Google Scholar 

  33. Graeb DA, Robertson WD, Lapointe JS, Nugent RA, Harrison PB. Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis. Radiology. 1982;143:91–6.

    PubMed  CAS  Google Scholar 

  34. Tuhrim S, Horowitz DR, Sacher M, Godbold JH. Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage. Crit Care Med. 1999;27:617–21.

    Article  PubMed  CAS  Google Scholar 

  35. Hallevi H, Dar NS, Barreto AD, Morales MM, Martin-Schild S, Abraham AT, Walker KC, Gonzales NR, Illoh K, Grotta JC, Savitz SI: The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications. Crit Care Med. 2009;37:969–74, e961.

    Google Scholar 

  36. Rost NS, Smith EE, Chang Y, Snider RW, Chanderraj R, Schwab K, FitzMaurice E, Wendell L, Goldstein JN, Greenberg SM, Rosand J. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke. 2008;39:2304–9.

    Article  PubMed  Google Scholar 

  37. Di Napoli M, Godoy DA. Clinical grading scales in spontaneous intracerebral hemorrhage. Stroke. 2007;38:e133–5 (author reply e136).

    Article  PubMed  Google Scholar 

  38. Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Anderson CS. Long-term disability after first-ever stroke and related prognostic factors in the Perth Community Stroke Study, 1989–1990. Stroke. 2002;33:1034–40.

    Article  PubMed  Google Scholar 

  39. Jorm AF, Korten AE. Assessment of cognitive decline in the elderly by informant interview. Br J Psychiatry. 1988;152:209–13.

    Article  PubMed  CAS  Google Scholar 

  40. Huttner HB, Steiner T, Hartmann M, Kohrmann M, Juettler E, Mueller S, Wikner J, Meyding-Lamade U, Schramm P, Schwab S, Schellinger PD. Comparison of ABC/2 estimation technique to computer-assisted planimetric analysis in warfarin-related intracerebral parenchymal hemorrhage. Stroke. 2006;37:404–8.

    Article  PubMed  Google Scholar 

  41. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol. 1989;42:703–9.

    Article  PubMed  CAS  Google Scholar 

  42. Weimar C, Ziegler A, Sacco RL, Diener HC, Konig IR. Predicting recovery after intracerebral hemorrhage—an external validation in patients from controlled clinical trials. J Neurol. 2009;256:464–9.

    Article  PubMed  Google Scholar 

  43. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, Karimi A, Shaw MD, Barer DH. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365:387–97.

    PubMed  Google Scholar 

  44. van Beijnum J, Lovelock CE, Cordonnier C, Rothwell PM, Klijn CJ, Al-Shahi Salman R. Outcome after spontaneous and arteriovenous malformation-related intracerebral haemorrhage: population-based studies. Brain. 2009;132:537–43.

    Article  PubMed  Google Scholar 

  45. Becker KJ, Baxter AB, Cohen WA, Bybee HM, Tirschwell DL, Newell DW, Winn HR, Longstreth WT Jr. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology. 2001;56:766–72.

    PubMed  CAS  Google Scholar 

  46. Zahuranec DB, Brown DL, Lisabeth LD, Gonzales NR, Longwell PJ, Smith MA, Garcia NM, Morgenstern LB. Early care limitations independently predict mortality after intracerebral hemorrhage. Neurology. 2007;68:1651–7.

    Article  PubMed  CAS  Google Scholar 

  47. Matchett SC, Castaldo J, Wasser TE, Baker K, Mathiesen C, Rodgers J. Predicting mortality after intracerebral hemorrhage: comparison of scoring systems and influence of withdrawal of care. J Stroke Cerebrovasc Dis. 2006;15:144–50.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. College of Physicians & Surgeons, Neurological Institute of New York, Columbia University, 710 West 168th Street, New York, NY, 10032, USA

    Brian Y. Hwang, Geoffrey Appelboom, Christopher P. Kellner, Amanda M. Carpenter, Michael A. Kellner, Paul R. Gigante & E. Sander Connolly

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  1. Brian Y. Hwang
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  2. Geoffrey Appelboom
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  3. Christopher P. Kellner
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  7. E. Sander Connolly
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Correspondence to Christopher P. Kellner.

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Hwang, B.Y., Appelboom, G., Kellner, C.P. et al. Clinical Grading Scales in Intracerebral Hemorrhage. Neurocrit Care 13, 141–151 (2010). https://doi.org/10.1007/s12028-010-9382-x

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  • DOI: https://doi.org/10.1007/s12028-010-9382-x

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