Practical scoring system for the identification of patients with intracerebral hemorrhage at highest risk of harboring an underlying vascular etiology: the Secondary Intracerebral Hemorrhage Score.
Practical scoring system for the identification of patients with intracerebral hemorrhage at highest risk of harboring an underlying vascular etiology: the Secondary Intracerebral Hemorrhage Score.
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DOI：
10.3174/ajnr.a2156
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发表时间：
2010-10
期刊：
影响因子：
--
通讯作者：
Romero JM
中科院分区：
文献类型：
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作者：
Delgado Almandoz JE;Schaefer PW;Goldstein JN;Rosand J;Lev MH;González RG;Romero JM
ICH 患者存在潜在血管病因的风险因基线临床和 NCCT 特征而异。我们的目标是开发一个实用的评分系统，根据脑出血患者存在血管病因的风险对脑出血患者进行分层。使用 9 年期间接受 MDCTA 评估的 623 名 ICH 患者的数据库，我们开发了一个基于基线临床特征（年龄组 [0–2 分]、性别 [0–1 分]、既不已知 HTN 也不凝血受损 [0–1 分]）和 NCCT 分类（0–2 分）的评分系统，以预测 ICH 病因包含血管病变的风险（SICH 评分）。随后，我们将 SICH 评分应用于 222 名 ICH 患者的前瞻性队列，这些患者在 13 个月的时间内就诊于我们的急诊科。使用 ROC 分析，我们分别计算了回顾性和前瞻性患者队列以及整个患者群体中 SICH 评分的 AUC 和 MOP。基底池患有 SAH 的患者被排除在外。通过MDCTA（14.2%）、最常见的AVM（45.8%）、纯粹实质内破裂的动脉瘤（21.7%）和DVST（16.7%）评估的845名ICH患者中，有120名发现了血管病因。 SICH 评分 >2 时达到 MOP，SICH 评分为 3 分（18.5%）、4 分（39%）、5 分（84.2%）和 6 分（100%）的患者血管性 ICH 病因发生率最高。两个患者队列之间的 AUC 无显着差异 (0.86–0.87)。 SICH 评分成功预测了特定 ICH 患者存在潜在血管病因的风险，并可用作选择 ICH 患者进行神经血管评估的指南，以排除血管异常的存在。
An ICH patient’s risk of harboring an underlying vascular etiology varies according to baseline clinical and NCCT characteristics. Our aim was to develop a practical scoring system to stratify patients with ICH according to their risk of harboring a vascular etiology. Using a data base of 623 patients with ICH evaluated with MDCTA during a 9-year period, we developed a scoring system based on baseline clinical characteristics (age group [0–2 points], sex [0–1 point], neither known HTN nor impaired coagulation [0–1 point]), and NCCT categorization (0–2 points) to predict the risk of harboring a vascular lesion as the ICH etiology (SICH score). We subsequently applied the SICH score to a prospective cohort of 222 patients with ICH who presented to our emergency department during a 13-month period. Using ROC analysis, we calculated the AUC and MOP for the SICH score in both the retrospective and prospective patient cohorts separately and the entire patient population. Patients with SAH in the basal cisterns were excluded. A vascular etiology was found in 120 of 845 patients with ICH evaluated with MDCTA (14.2%), most commonly AVMs (45.8%), aneurysms with purely intraparenchymal rupture (21.7%), and DVSTs (16.7%). The MOP was reached at a SICH score of >2, with the highest incidence of vascular ICH etiologies in patients with SICH scores of 3 (18.5%), 4 (39%), 5 (84.2%), and 6 (100%). There was no significant difference in the AUC between both patient cohorts (0.86–0.87). The SICH score successfully predicts a given ICH patient’s risk of harboring an underlying vascular etiology and could be used as a guide to select patients with ICH for neurovascular evaluation to exclude the presence of a vascular abnormality.