Clinical Grading Scales for Predicting Early Neurological Worsening in Spontaneous Intracerebral Hemorrhage
Introduction: Early neurological worsening (ENW) is a major determinant of death in spontaneous intracerebral hemorrhage. In recent years, several clinical grading scales have been developed to identify patients at risk of 30-day or 90-day poor outcome following spontaneous (ICH), but whether these are able to predict ENW remains unclear. The aim of our study was to validate and compare two ICH grading scales for predicting ENW.
Methods: Original (o) ICH and FUNC scores were calculated for 128 consecutive, prospectively-collected ICH patients using components and cutoff values identical to those described in the original derivation cohorts. Receiver operating characteristic (ROC) analysis, including area under the curve (AUC), was used to assess the ability of each score to predict ENW.
Results: Overall, thirty-day mortality rate was 33.6% (n=43), while only 19 (15.3%) patients had good outcome at 90-days. ENW was evident in 40 patients (31.3%). Compared with patients without ENW, patients with ENW had significantly higher in-hospital mortality (79.1% vs 5%, p=0.0001), mortality within 48 hours (56.5% vs 0%,p=0.0001), baseline hematoma volume greater than 30 mm3(85.4% vs 20%, p=0.0001), baseline intraventricular bleeding (83% vs 16.25%, p=0.0001), hematoma enlargement in second brain CT (34% vs 2.5%, p=0.0001),history of vitamin K antagonists or antiplatelet treatment (75% vs 46.25%, p=0.001), lower median Glasgow Coma Scale at baseline (9.5 vs 15, p=0.001), higher median oICH score at baseline (4 vs 1, p=0.001), lower FUNC score at baseline (4.5 vs 8, p=0.001). Both scores were accurate predictors of study outcomes demonstrating excellent discrimination (AUC>0.80). However, oICH score permitted a correct ENW risk reclassification in 26% of patients.
Conclusions: oICH and FUNC scores are appropriate tools to assess ENW, with potential applications to clinical practice and research.
Luca Masotti, Gianni Lorenzini, Paolo Pennati, Daniel Agustin Godoy, Aurel Popa-Wagner, J Claude Hemphill, Adrian R Parry- Jones, Réza Behrouz, Natalia S Rost and Mario Di Napoli
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