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. 2021 Jan 6;3(1):1.
doi: 10.1186/s42466-020-00100-1.

Probability assessment of intracerebral hemorrhage in prehospital emergency patients

Frederik Geisler  1 , Medschid Wesirow  2 , Martin Ebinger  3 , Alexander Kunz  3 , Michal Rozanski  4 , Carolin Waldschmidt  5 , Joachim E Weber  2 , Matthias Wendt  6 , Benjamin Winter  7 , Heinrich J Audebert  2   8
Affiliations

Probability assessment of intracerebral hemorrhage in prehospital emergency patients

Frederik Geisler et al. Neurol Res Pract. .

Abstract

Background: Routing of patients with intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) to the most appropriate hospital is challenging for emergency medical services particularly when specific treatment options are only provided by specialized hospitals and determination of the exact diagnosis is difficult. We aimed to develop a prehospital score - called prehospital-intracerebral hemorrhage score (ph-ICH score) - to assist in discriminating between both conditions.

Methods: The ph-ICH score was developed with data from patients treated aboard a mobile stroke unit in Berlin, Germany, between 2011 and 2013 (derivation cohort) and in 2018 (validation cohort). Diagnosis of ICH or AIS was established using clinical data and neuroradiological cerebral imaging. Diagnostic accuracy was measured with significance testing, Cohen's d and receiver-operating-characteristics.

Results: We analyzed 416 patients (32 ICH, 224 AIS, 41 transient ischemic attack, 119 stroke mimic) in the derivation cohort and 285 patients (33 ICH and 252 AIS) in the validation cohort. Systolic blood pressure, level of consciousness and severity of neurological deficits (i. e. certain items of the National Institutes of Health Stroke Scale) were used to calculate the ph-ICH score that showed higher values in the ICH compared to the AIS group (derivation cohort: 1.8 ± 1.2 vs. 1.0 ± 0.9 points; validation cohort: 1.8 ± 0.9 vs. 0.8 ± 0.7 points; d = 0.9 and 1.4, both p < 0.01). Receiver-operating-characteristics showed fair and good accuracy with an area under the curve of 0.71 for the derivation and 0.81 for the validation cohort.

Conclusions: The ph-ICH score can assist medical personnel in the field to assess the likelihood of ICH and AIS in emergency patients.

Keywords: Emergency medical services; Intracerebral hemorrhage; Ischemic stroke; Mobile stroke unit; Vascular neurology.

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Conflict of interest statement

FG owns stocks in JNJ and ABBV (not involved in any form in the trial), HA received speaker honoraria from Boehringer Ingelheim (BI, manufacturer of alteplase; not involved in any form in the trial).

Figures

Fig. 1
Fig. 1
Flow Chart. All patients who were included in the derivation cohort of this study as well as the reasons for exclusion are depicted in the Flow Chart
Fig. 2
Fig. 2
ROC curve. ROC curve with the AUC for the derivation and validation cohort. a shows the AIS/TIA/SM group for the derivation cohort, b the AIS group for the derivation cohort and C the AIS group for the validation cohort. AIS: acute ischemic stroke; AUC: area under the curve; ICH: intracerebral hemorrhage; ROC: receiver-operating-characteristics; SM: stroke mimic
See this image and copyright information in PMC

References

    1. Hankey GJ. Stroke. Lancet. 2017;389(10069):641–654. doi: 10.1016/S0140-6736(16)30962-X. - DOI - PubMed
    1. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064–2089. doi: 10.1161/STR.0b013e318296aeca. - DOI - PMC - PubMed
    1. Yamaguchi Y, Koga M, Sato S, Yamagami H, Todo K, Okuda S, et al. Early achievement of blood pressure lowering and hematoma growth in acute intracerebral hemorrhage: Stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study. Cerebrovascular Diseases. 2018;46(3–4):118–124. - PubMed
    1. Runchey S, McGee S. Does this patient have a hemorrhagic stroke?: Clinical findings distinguishing hemorrhagic stroke from ischemic stroke. JAMA. 2010;303(22):2280–2286. doi: 10.1001/jama.2010.754. - DOI - PubMed
    1. Badam P, Solao V, Pai M, Kalantri SP. Poor accuracy of the Siriraj and Guy's hospital stroke scores in distinguishing haemorrhagic from ischaemic stroke in a rural, tertiary care hospital. National Medical Journal of India. 2003;16(1):8–12. - PubMed

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