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Abstract
Objective We tested the hypothesis that the maximally treated intracerebral hemorrhage (max-ICH) score is superior to the ICH score for characterizing mortality and functional outcome prognosis in patients with ICH, particularly those who receive maximal treatment.
Methods Patients presenting with spontaneous ICH were enrolled in a prospective observational study that collected demographic and clinical data. Mortality and functional outcomes were measured by using the modified Rankin Scale at 3 months. The ICH score and max-ICH score incorporate measures of symptom severity, age, hematoma volume, hematoma location, and intraventricular hemorrhage, with the max-ICH score also including a term for oral anticoagulation and having 16 score categories vs 11 for the ICH score. We compared the area under the receiver operating characteristic curve (AUC) for the ICH score and max-ICH score for both mortality and poor functional outcome, defined as modified Rankin Scale scores 4–6.
Results We analyzed outcomes for 372 patients, including 71 patients (19%) in whom care limitation/withdrawal of life support was instituted. Both the ICH score and max-ICH score showed good prognostic performance for 3-month mortality and poor functional outcomes in the full group as well as the subgroup with maximal treatment (i.e., no care limitations; AUC range 0.80–0.86), with no significant difference in AUC between the scores for either endpoint in either group.
Conclusions External validation with direct comparison of the ICH score and max-ICH score shows that their prognostic performance is not meaningfully different. Alternatives to simple scores are likely needed to improve prognostic estimates for patient care decisions.
Glossary
- AUC=
- area under the receiver operating characteristic curve;
- FOS=
- functional outcome score;
- GCS=
- Glasgow Coma Scale;
- ICH=
- intracerebral hemorrhage;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- ROC=
- receiver operating characteristic;
- TRIPOD=
- Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received July 17, 2017.
- Accepted in final form June 6, 2018.
- © 2018 American Academy of Neurology
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