Neurosurgery Blog: The SEDAN Score and the Risk of Intracerebral Hemorrhage in Monocenter-Study (S25.003)

Monday, April 21, 2014

The SEDAN Score and the Risk of Intracerebral Hemorrhage in Monocenter-Study (S25.003)

Neurology recent issues

Objective: to evaluate the SEDAN score predicting the risk of a symptomatic intracerebral hemorrhage (sICH) after intravenous thrombolysis with rt-PA (IV thrombolysis) in monocenter study and to investigate its association with outcomes.Background: The risk of sICH is a serious complication after IV thrombolysis. The fear of sICH may limit the implementation of treatment with IV thrombolysis.A score (SEDAN, 0-6 points), which is based on blood Sugar, Early infarct sign, Dense artery sign, Age (>75 years) and NIHSS score (蠅10), has been suggested to predict the risk of sICH after IV thrombolysis.Methods: During 2.5-years period (starting March 2011), 315 consecutive stroke patients (mean age, 73± 13years; 51,1% women; median NIHSS score, 10) who were treated with IV thrombolysis were included and evaluated in a monocenter-study in Germany.We used logistic regression to estimate the odds ratio (OR) and Hosmer-Lemeshow-test to compare the expected and the observed probability of sICH.Results: Among 315 patients, 36 (11.5%, 95%-CI, 8.0-15%) suffered from sICH after IV thrombolysis. The frequency of sICH was; 0%, 4.8%, 10.7%, 18.8%, 25.8% and 33.3% for 0, 1, 2, 3, 4, and 蠅5 score points. In the logistic regression, an increase of SEDAN score was associated with rising of sICH risk (OR, 1.94 per SEDAN score point, 95%-CI, 1.45-2.6; P<0.001). Hosmer-Lemeshow-test revealed that the expected and observed rates of sICH were 88.5% similar (chi-square=1.8, df=3, P=0.6).Thirty five patients (11.0%, 95%-CI, 8-14.6%) died during a median hospital stay of 9 days, whereas 76 of 257 patients (29.6%, 95%-CI, 24-35%) died during a median follow-up of 14 months. With rising of SEDAN score, the in-hospital mortality (OR, 1.65; 95%-CI, 1.25-2.2, P<0.001) as well as the follow-up mortality (OR, 1.67; 95%-CI, 1.33-2.1; P<0.001) appear to be increased.Conclusion: Patients with higher SEDAN score may be at higher risk of sICH and death after treatment with IV thrombolysis.

Disclosure: Dr. Bruning has nothing to disclose. Dr. Al-Khaled has nothing to disclose.

Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/S25.003?rss=1