Clinical Grading Scales in Intracerebral Hemorrhage
Clinical Grading Scales in Intracerebral Hemorrhage
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DOI：
10.1007/s12028-010-9382-x
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发表时间：
2010-08-01
影响因子：
3.5
通讯作者：
Connolly, E. Sander
中科院分区：
文献类型：
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作者：
Hwang, Brian Y.;Appelboom, Geoffrey;Connolly, E. Sander
脑出血（ICH）比任何其他形式的卒中具有更高的长期残疾和死亡风险。尽管对ICH的病理生理学有了更多的了解，但这种破坏性疾病的治疗选择仍然有限。此外，缺乏标准的、普遍接受的ICH临床分级量表导致了管理方案和临床试验设计的变化。分级量表对于医生之间的标准化评估和沟通，选择优化的治疗方案和设计有效的临床试验至关重要。目前存在许多针对死亡率和/或功能结局（特别是ICH发作后30天）开发的ICH分级量表和预后模型。许多可靠的量表已在异质人群中进行了外部验证。我们根据其开发和验证方法，广泛审查了所有现有临床ICH分级量表的固有优势和局限性。对于所有ICH分级量表，我们仔细观察了研究设计以及结局评估的定义和时间，以阐明分级量表推导和应用中的不一致性。最终，我们呼吁进行一项广泛的、前瞻性的、多中心的临床结局研究，以明确ICH的各个方面，建立理想的分级量表和标准化的管理方案，从而能够识别ICH的新型有效治疗方法。
Intracerebral hemorrhage (ICH) carries higher risk of long-term disability and mortality than any other form of stroke. Despite greater understanding of ICH pathophysiology, treatment options for this devastating condition remain limited. Moreover, a lack of a standard, universally accepted clinical grading scale for ICH has contributed to variations in management protocols and clinical trial designs. Grading scales are essential for standardized assessment and communication among physicians, selecting optimized treatment regiments, and designing effective clinical trials. There currently exist a number of ICH grading scales and prognostic models that have been developed for mortality and/or functional outcome, particularly 30 days after the ICH onset. Numerous reliable scales have been externally validated in heterogeneous populations. We extensively reviewed the inherent strengths and limitations of all the existing clinical ICH grading scales based on their development and validation methodology. For all ICH grading scales, we carefully observed study design and the definition and timing of outcome assessment to elucidate inconsistencies in grading scale derivation and application. Ultimately, we call for an expansive, prospective, multi-center clinical outcome study to clearly define all aspects of ICH, establish ideal grading scales, and standardized management protocols to enable the identification of novel and effective therapies in ICH.