Validation of ICH score in a large urban population

Abstract

Objectives: Hemorrhagic stroke cause around 10-20% of all strokes. ICH (Intracerebral Hemorrhage) score is a grading scale used to determine survival outcome after nontraumatic ICH at 30 days. It is a 6-point scale based on 5 independent variables, which are graded based on the weight of their association. These 5 variables are the Glasgow coma scale (GCS), ICH Volume, Intraventricular hemorrhage (IVH), Infratentorial origin and age. The aim of our study is to validate the ICH score in our population.

Materials and methods: We conducted a retrospective chart review of 245 adult patients who presented with acute ICH to University Hospital, Newark between 1/1/2012 to 12/30/2015. GCS recorded in Emergency Department was used. Initial Computed tomography (CT) Head was used for calculating volume, IVH, and location origin, while ICH Volume was calculated using the ABC/2 method. The primary outcome was 30-day mortality. Patients with a hemorrhagic transformation of ischemic strokes or traumatic ICH were excluded.

Results: 245 patients met our inclusion criteria. 30-day mortality was 36%. ICH scores ranged from 0 to 5, and an increase in the ICH score was associated with an increase in 30-day mortality. 4 variables in the ICH score had a significant association with 30-day mortality: ICH Volume ≥30 ml (OR, 17.24; 95% CI, 8.33-35.66; P < 0.001), IVH (OR, 6.91; 95% CI, 3.72-12.85; P < 0.001), low GCS (P < 0.001) and infratentorial origin of bleed significant (OR, 2.17; 95% CI, 1.07-4.40; P 0.039). However, the association of age ≥ 80 years with respect to 30-day mortality wasn't statistically significant in our group (OR, 1.49; 95% CI, 0.70-3.17; P 0.325).

Conclusions: Our study is one of the largest done at a single urban center to validate the ICH score. Age ≥ 80 years wasn't statistically significant with respect to 30-day mortality in our group. Restratification of the weight of individual variable in the ICH equation with modification of the ICH score can potentially more accurately establish mortality risk. Nevertheless, the overall prediction of mortality was accurate and reproducible in our study.

Keywords: Acute stroke outcome; Hemorrhagic stroke; ICH; ICH score; Intracerebral hemorrhage; Prognosis; Prognostic methods.