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External validation of the ICH score

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Abstract

Introduction: The ICH score is a clinical grading scale that is composed of five components related to outcome after nontraumatic intracerebral hemorrhage (ICH): Glasgow Coma Scale score, ICH volume, presence of intraventricular hemorrhage, infratentorial origin, and age. The ICH score accurately risk-stratifies patients in the cohort from which it was developed, but it has not yet been fully externally validated. The purpose of this study was to determine whether the ICH score accurately risk-stratifies patients in an independent cohort.

Methods: Records of all patients with acute ICH presenting to Stanford Medical Center and Santa Clara Valley Medical Center from 1998 through 2000 were reviewed. Outcome was assessed as mortality at 30 days.

Results: A total of 175 patients formed the cohort for analysis. Thirty-day mortality for the entire cohort was 40%. ICH scores ranged from 0 to 5, and each increase in the ICH score was associated with an increase in 30-day mortality (p<0.01 for trend); 4 of 41 patients with an ICH score of 0 died, whereas all 5 patients with a score of 5 died. Receiver operating characteristic curves for the ICH score were similar for this cohort and for the initial ICH score cohort.

Conclusion: The ICH score accurately stratifies outcome in an external patient cohort. Thus, the ICH score is a validated clinical grading scale that can be easily and rapidly applied at ICH presentation. A scale such as the ICH score could be used to standardize clinical treatment protocols or clinical studies.

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References

  1. Caplan LR. Intracerebral haemorrhage. Lancet 1992;339:656–658.

    Article  PubMed  CAS  Google Scholar 

  2. Broderick JP, Brott T, Tomsick T, Miller R, Huster G. Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 1993;78:188–191.

    PubMed  CAS  Google Scholar 

  3. Broderick JP, Adams HP, Jr., Barsan W, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1999;30:905–915.

    PubMed  CAS  Google Scholar 

  4. Auer LM, Deinsberger W, Niederkorn K, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: A randomized study. J Neurosurg 1989;70:530–535.

    PubMed  CAS  Google Scholar 

  5. Batjer HH, Reisch JS, Allen BC, Plaizier LJ, Su CJ. Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial. Arch Neurol 1990;47:1103–1106.

    PubMed  CAS  Google Scholar 

  6. Poungvarin N, Bhoopat W, Viriyavejakul A, et al. Effects of dexamethasone in primary supratentorial intracerebral hemorrhage. N Engl J Med 1987;316:1229–1233.

    Article  PubMed  CAS  Google Scholar 

  7. Yu YL, Kumana CR, Lauder IJ, et al. Treatment of acute cerebral hemorrhage with intravenous glycerol. A double-blind, placebo-controlled, randomized trial. Stroke 1992;23:967–971.

    PubMed  CAS  Google Scholar 

  8. Zuccarello M, Brott T, Derex L, et al. Early surgical treatment for supratentorial intracerebral hemorrhage: A randomized feasibility study. Stroke 1999;30:1833–1839.

    PubMed  CAS  Google Scholar 

  9. Tuhrim S, Dambrosia JM, Price TR, et al. Intracerebral hemorrhage: External validation and extension of a model for prediction of 30-day survival. Ann Neurol 1991;29:658–663.

    Article  PubMed  CAS  Google Scholar 

  10. Lisk DR, Pasteur W, Rhoades H, Putnam RD, Grotta JC. Early presentation of hemispheric intracerebral hemorrhage: Prediction of outcome and guidelines for treatment allocation. Neurology 1994;44:133–139.

    PubMed  CAS  Google Scholar 

  11. 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;27:617–621.

    Article  PubMed  CAS  Google Scholar 

  12. Hemphill JC, 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: A simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001;32:891–897.

    PubMed  Google Scholar 

  13. 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;24:987–993.

    PubMed  CAS  Google Scholar 

  14. Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke 1996;27:1304–1305.

    PubMed  CAS  Google Scholar 

  15. Hill ME. Comparison of National Death Index and world wide web death searches. Am J Epidemiol 2001;153:719.

    Article  PubMed  CAS  Google Scholar 

  16. Sesso HD, Paffenbarger RS, Lee IM. Comparison of National Death Index and World Wide Web death searches. Am J Epidemiol 2000;152:107–111.

    Article  PubMed  CAS  Google Scholar 

  17. Cuzick J. A Wilcoxon-type test for trend. Stat Med 1985;4:87–90.

    Article  PubMed  CAS  Google Scholar 

  18. Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg 1988;68:985–986.

    Google Scholar 

  19. 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 

  20. Spetzler RF, Martin NA. Aproposed grading system for arteriovenous malformations. J Neurosurg 1986;65:476–483.

    PubMed  CAS  Google Scholar 

  21. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81–84.

    Article  PubMed  CAS  Google Scholar 

  22. Brott T, Adams HP, Jr., Olinger CP, et al. Measurements of acute cerebral infarction: A clinical examination scale. Stroke 1989;20:864–870.

    PubMed  CAS  Google Scholar 

  23. Juarez VJ, Lyons M. Interrater reliability of the Glasgow Coma Scale. J Neurosci Nurs 1995;27:283–286.

    PubMed  CAS  Google Scholar 

  24. Menegazzi JJ, Davis EA, Sucov AN, Paris PM. Reliability of the Glasgow Coma Scale when used by emergency physicians and paramedics. J Trauma 1993;34:46–48.

    PubMed  CAS  Google Scholar 

  25. Juvela S. Risk factors for impaired outcome after spontaneous intracerebral hemorrhage. Arch Neurol 1995;52:1193–1200.

    PubMed  CAS  Google Scholar 

  26. Poungvarin N, Viriyavejakul A, Komontri C. Siriraj stroke score and validation study to distinguish supratentorial intracerebral haemorrhage from infarction. Br Med J 1991;302:1565–1567.

    CAS  Google Scholar 

  27. Tuhrim S, Horowitz DR, Sacher M, Godbold JH. Validation and comparison of models predicting survival following intracerebral hemorrhage. Crit Care Med 1995;23:950–954.

    Article  PubMed  CAS  Google Scholar 

  28. Fernandes H, Gregson BA, Siddique MS, Mendelow AD. Testing the ICH Score. Stroke 2002;33:1455–1456.

    Article  PubMed  Google Scholar 

  29. Jamora R, Kishi-Generao, Jr., E, Bitanga E, Gan R, Apaga N, San Jose M. The ICH score: Predicting mortality and functional outcome in an Asian population. Stroke 2003;34:6–7.

    Article  PubMed  Google Scholar 

  30. The National Institute of Neurological Disorders and Strokert-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1587.

    Article  Google Scholar 

  31. Clifton GL, Miller ER, Choi SC, et al. Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001;344:556–563.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, University of California, San Francisco

    Jennifer L. Clarke, S. Claiborne Johnston, Mary Farrant & J. Claude Hemphill MD

  2. Stanford Stroke Center, Palo Alto, CA

    Richard Bernstein & David Tong

Authors
  1. Jennifer L. Clarke
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  2. S. Claiborne Johnston
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  3. Mary Farrant
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  4. Richard Bernstein
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  5. David Tong
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  6. J. Claude Hemphill MD
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Correspondence to J. Claude Hemphill MD.

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Clarke, J.L., Johnston, S.C., Farrant, M. et al. External validation of the ICH score. Neurocrit Care 1, 53–60 (2004). https://doi.org/10.1385/NCC:1:1:53

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