Background: The ICH score was developed as a simple grading scale to predict 30 day outcome. This scale is often applied to individuals presenting in time periods after hematoma expansion and clinical deterioration. We aimed to validate the ICH score in a modern cohort of presenting hyper-acutely <2 hours from symptom onset.Methods: Using NIH Field Administration of Stroke Therapy Magnesium (FAST-MAG) database, a cohort of 364 consecutive patients with spontaneous ICH on initial imaging, met criteria for inclusion. The ICH size was calculated using the abc/2 method. GCS was obtained in the ED. Poor outcome at 3 months was defined as mRS 4-6 and death as mRS 6.Results:There were 364 consecutive ICH cases mean age 65 (SD13), 34% women, 33% Hispanic ethnicity, 78% white race, 77% with history of hypertension and 19% diabetes. Median time from last known well to EMS evaluation was 23 minutes (IQR 14-40) and to ED arrival was 58 (46-76) minutes. ICH volume ranged from 0.1cc to 300 cc, with median volume of 15.3 (IQR 7-39) cc. ICH score predicted mortality and poor outcome (p<0.0001). For a score of 0 (N=115) poor outcome was 25%, mortality was 7%. For a score of 1 (N=113) poor outcome was 52% and mortality was 12%. For a score of 2 (N=55) poor outcome was 84% and mortality was 44%. ICH score of 3 (N= 41) had 95% poor outcome and 51% mortality. ICH score of 4 (N= 32) poor outcome was 100%, mortality was 72%. A score of 5 (N= 8) poor outcome of 100% and mortality of 63%.Conclusions: In the hyperacute setting, all patients with ICH score >=4 had poor outcome. Less than 10%of the patients with an ICH score >=2 had a good outcome.
Disclosure: Dr. Bulic has nothing to disclose. Dr. Sanossian has received personal compensation for activities with Boehringer-Ingelheim Pharmaceutical Inc. Dr. Starkman has received research support from the National Institutes of Health, Lundbeck, Mitsubishi, and NTI. Dr. Liebeskind has received personal compensation for activities with Concentric Medical, Inc. and CoAxia, Inc. Dr. Villablanca has nothing to disclose. Dr. Hamilton has nothing to disclose. Dr. Conwit has nothing to disclose. Dr. Saver has received personal compensation for activities with the University of California, BrainsGate, CoAxia, ev3, Talecris, PhotoThera, Sygnis, and Stryker. Dr. Saver has received research support from the University of California, and the National Institutes of Health.
Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/S25.004?rss=1
Júlio Pereira
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