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. 2018 Aug 13;8(8):e021719.
doi: 10.1136/bmjopen-2018-021719.

Validation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain

Sonia Rodríguez-Fernández  1   2 , Encarnación Castillo-Lorente  3 , Francisco Guerrero-Lopez  3 , David Rodríguez-Rubio  4 , Eduardo Aguilar-Alonso  5 , Jesús Lafuente-Baraza  4 , Francisco Javier Gómez-Jiménez  2 , Juan Mora-Ordóñez  6 , Ricardo Rivera-López  7 , María Dolores Arias-Verdú  6 , Guillermo Quesada-García  6 , Miguel Ángel Arráez-Sánchez  8 , Ricardo Rivera-Fernández  9
Affiliations

Validation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain

Sonia Rodríguez-Fernández et al. BMJ Open. .

Abstract

Objective: Validation of the intracerebral haemorrhage (ICH) score in patients with a diagnosis of spontaneous ICH admitted to the intensive care unit (ICU).

Methods: A multicentre cohort study was conducted in all consecutive patients with ICH admitted to the ICUs of three hospitals with a neurosurgery department between 2009 and 2012 in Andalusia, Spain. Data collected included ICH, Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores. Demographic data, location and volume of haematoma and 30-day mortality rate were also collated.

Results: A total of 336 patients were included. 105 of whom underwent surgery. Median (IQR) age: 62 (50-70) years.

Apache-ii: 21(15-26) points, GCS: 7 (4-11) points, ICH score: 2 (2-3) points. 11.1% presented with bilateral mydriasis on admission (mortality rate=100%). Intraventricular haemorrhage was observed in 58.9% of patients. In-hospital mortality was 54.17% while the APACHE-II predicted mortality was 57.22% with a standardised mortality ratio (SMR) of 0.95 (95% CI 0.81 to 1.09) and a Hosmer-Lemenshow test value (H) of 3.62 (no significant statistical difference, n.s.). 30-day mortality was 52.38% compared with the ICH score predicted mortality of 48.79%, SMR: 1.07 (95% CI 0.91 to 1.23), n.s. Mortality was higher than predicted at the lowest scores and lower than predicted in the more severe patients, (H=55.89, p<0.001), Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva calibration belt (p<0.001). The area under a receiver operating characteristic (ROC) curve was 0.74 (95% CI 0.69 to 0.79).

Conclusions: ICH score shows an acceptable discrimination as a tool to predict mortality rates in patients with spontaneous ICH admitted to the ICU, but its calibration is suboptimal.

Keywords: ICH score; ICU; intracerebral haemorrhage; mortality; prognostic model.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Predicted versus observed hospital mortality for APACHE-II model. APACHE-II, Acute Physiology and Chronic Health Evaluation II.
Figure 2
Figure 2
APACHE-II calibration. APACHE-II, Acute Physiology and Chronic Health Evaluation II.
Figure 3
Figure 3
ICH calibration. ICH, intracerebral haemorrhage.
See this image and copyright information in PMC

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