Publication year: 2011
Source: World Neurosurgery, Available online 10 December 2011
Geoffrey Appelboom, Brian Y. Hwang, Samuel S. Bruce, Matthew A. Piazza, Christopher P. Kellner, ...
BackgroundArteriovenous malformation-associated intracerebral hemorrhage (AVM-ICH) is an important cause of ICH, which is associated with significantly different epidemiology, clinical course and outcome as compared to primary ICH. The original ICH (oICH) score is the most commonly used ICH clinical grading scale for risk-stratification and outcome prediction after spontaneous ICH. However, the score has been validated in cohorts that consist mostly of primary ICH and its accuracy in the setting of AVM-ICH remains unknown. We sought to evaluate the predictive ability of the oICH score in a large independent cohort of AVM-ICH patients.MethodsBetween 1997 to 2009, 91 patients were admitted to Columbia Medical Center with acute AVM-ICH. Demographic and admission clinical and radiographic variables were obtained for 84 patients through retrospective chart review. Admission oICH score and Spetzler-Martin Grading Scale (SMGS) were calculated. Outcome was assessed at 3-month using the modified Rankin Score (mRS). Maximum Youden Indices were used to identify cutoffs for age and ICH volume that are associated with optimal predictive accuracy for unfavorable outcome (mRS ≥ 3). Receiver operating characteristic (ROC) analysis was used to evaluate the predictive performance of oICH score, and oICH score with new age and ICH cut-off points (AVM-oICH score).ResultsThe mean age and ICH volume were 35 ± 14 years and 22 ± 20 mL, respectively. Three patients (4%) were dead and 15 (18%) had unfavorable outcome at 3-month follow-up. Of the 3 patients that died, two had an oICH score of 3 and one had an oICH score of 5. The ICH volume of 37 mL and age of 41 years were identified as optimal cutoffs for predicting unfavorable outcome. The oICH and AVM-oICH scores demonstrated good predictive accuracies with area under the curve (AUC) of 0.914 and 0.891, respectively (p = 0.422). The AVM-oICH and oICH scores had similarly high sensitivities (0.889 and 0.944, respectively; p = 1.00) but the former had significantly greater specificity (0.879 vs. 0.682, p < 0.001).ConclusionsThe oICH is a valid clinical grading scale with high predictive accuracy for functional outcome after AVM-ICH. It is unclear whether the score is appropriate for risk stratification with regard to mortality due to the low risk of death associated with AVM-ICH. Simple adjustments of the age and ICH volume cut-off points improves the score's performance and reduce the probability of overestimating one's risk of unfavorable outcome after AVM-ICH.
Source: World Neurosurgery, Available online 10 December 2011
Geoffrey Appelboom, Brian Y. Hwang, Samuel S. Bruce, Matthew A. Piazza, Christopher P. Kellner, ...
BackgroundArteriovenous malformation-associated intracerebral hemorrhage (AVM-ICH) is an important cause of ICH, which is associated with significantly different epidemiology, clinical course and outcome as compared to primary ICH. The original ICH (oICH) score is the most commonly used ICH clinical grading scale for risk-stratification and outcome prediction after spontaneous ICH. However, the score has been validated in cohorts that consist mostly of primary ICH and its accuracy in the setting of AVM-ICH remains unknown. We sought to evaluate the predictive ability of the oICH score in a large independent cohort of AVM-ICH patients.MethodsBetween 1997 to 2009, 91 patients were admitted to Columbia Medical Center with acute AVM-ICH. Demographic and admission clinical and radiographic variables were obtained for 84 patients through retrospective chart review. Admission oICH score and Spetzler-Martin Grading Scale (SMGS) were calculated. Outcome was assessed at 3-month using the modified Rankin Score (mRS). Maximum Youden Indices were used to identify cutoffs for age and ICH volume that are associated with optimal predictive accuracy for unfavorable outcome (mRS ≥ 3). Receiver operating characteristic (ROC) analysis was used to evaluate the predictive performance of oICH score, and oICH score with new age and ICH cut-off points (AVM-oICH score).ResultsThe mean age and ICH volume were 35 ± 14 years and 22 ± 20 mL, respectively. Three patients (4%) were dead and 15 (18%) had unfavorable outcome at 3-month follow-up. Of the 3 patients that died, two had an oICH score of 3 and one had an oICH score of 5. The ICH volume of 37 mL and age of 41 years were identified as optimal cutoffs for predicting unfavorable outcome. The oICH and AVM-oICH scores demonstrated good predictive accuracies with area under the curve (AUC) of 0.914 and 0.891, respectively (p = 0.422). The AVM-oICH and oICH scores had similarly high sensitivities (0.889 and 0.944, respectively; p = 1.00) but the former had significantly greater specificity (0.879 vs. 0.682, p < 0.001).ConclusionsThe oICH is a valid clinical grading scale with high predictive accuracy for functional outcome after AVM-ICH. It is unclear whether the score is appropriate for risk stratification with regard to mortality due to the low risk of death associated with AVM-ICH. Simple adjustments of the age and ICH volume cut-off points improves the score's performance and reduce the probability of overestimating one's risk of unfavorable outcome after AVM-ICH.
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