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Multicenter Study
. 2013 Mar;44(3):635-41.
doi: 10.1161/STROKEAHA.112.670653. Epub 2013 Jan 31.

The Modified Graeb Score: an enhanced tool for intraventricular hemorrhage measurement and prediction of functional outcome

Timothy C Morgan  1 , Jesse Dawson, Danielle Spengler, Kennedy R Lees, Chanel Aldrich, Nishant K Mishra, Karen Lane, Terence J Quinn, Marie Diener-West, Christopher J Weir, Peter Higgins, Mark Rafferty, Katie Kinsley, Wendy Ziai, Issam Awad, Matthew R Walters, Daniel Hanley; CLEAR and VISTA Investigators
Affiliations
Multicenter Study

The Modified Graeb Score: an enhanced tool for intraventricular hemorrhage measurement and prediction of functional outcome

Timothy C Morgan et al. Stroke. 2013 Mar.

Abstract

Background and purpose: Simple and rapid measures of intraventricular hemorrhage (IVH) volume are lacking. We developed and validated a modification of the original Graeb scale to facilitate rapid assessment of IVH over time.

Methods: We explored the relationship between the modified Graeb scale (mGS), original Graeb scale, measured IVH volume, and outcome using data from the Clot Lysis: Evaluating Accelerated Resolution of Hemorrhage with rtPA B (CLEAR B) study. We also explored its reliability. We then evaluated the relationship between mGS and outcome in a large sample of participants with IVH using data contained within the Virtual International Stroke Trials Archive (VISTA). We defined outcome using the modified Rankin scale (>3 signifying poor outcome).

Results: The CLEAR B study included 360 scans from 36 subjects. The mGS score and IVH volume were highly correlated (R = 0.80, P<0.0001, R(2) 0.65). Baseline mGS was predictive of poor outcome (area under receiving operating characteristic curve 0.74, 95% confidence interval, 0.57-0.91), whereas the original Graeb scale was not. The VISTA study included 399 participants. Each unit increase in the mGS led to a 12% increase in the odds of a poor outcome (odds ratio, 1.12; 95% confidence interval, 1.05-1.19). Measures of reliability (intra- and inter- reader) were good in both studies.

Conclusions: The mGS, a semiquantitative scale for IVH volume measurement, is a reliable measure with prognostic validity suitable for rapid use in clinical practice and in research.

Trial registration: ClinicalTrials.gov NCT00650858.

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Figures

Figure 1.
Figure 1.
The modified Graeb scale.
Figure 2.
Figure 2.
Scatter plot of measured intraventricular hemorrhage volume in milliliters vs the original and modified Graeb scores.
Figure 3.
Figure 3.
Receiver operating characteristics curves for baseline intraventricular hemorrhage (IVH), original Graeb score (oGS), and modified Graeb score (mGS) for prediction of poor day-180 outcome. Area under the curve for baseline IVH 0.74 (95% CI, 0.58–0.91). AUC for mGS 0.74 (95% CI, 0.57–0.90). AUC for oGS 0.63 (95% CI, 0.45–0.82).
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