Enhanced Detection of Edema in Malignant Anterior Circulation Stroke (EDEMA) Score: A Risk Prediction Tool.
Enhanced Detection of Edema in Malignant Anterior Circulation Stroke (EDEMA) Score: A Risk Prediction Tool.
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DOI：
10.1161/strokeaha.117.016733
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发表时间：
2017-07
期刊：
影响因子：
8.3
通讯作者：
Lee JM
中科院分区：
文献类型：
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作者：
Ong CJ;Gluckstein J;Laurido-Soto O;Yan Y;Dhar R;Lee JM
快速识别卒中后恶性水肿的高危人群将有助于监测和潜在手术的分类。入院数据可能不足以做出准确的分诊决定。我们开发了一个风险预测评分，使用临床和影像学变量在发病后24小时内，以更好地预测潜在致命的恶性水肿（PLME）。纳入诊断代码为“脑水肿”和“缺血性卒中”、NIHSS ≥ 8、卒中发作24小时内头部CT检查的患者。PLME的主要结局定义为中线移位（MLS）≥ 5 mm或半颅骨切除减压术的死亡。我们对发作后24小时内的可用数据进行了多变量分析。Bootstrapping用于内部验证模型，并根据结果构建风险评分。222例患者中有33%发生PLME。推导队列中的最终模型c-统计量为0.76（CI 0.68-0.82），自举验证样本中为0.75（0.72-0.77）。使用以下独立预测因素制定水肿评分：基底池消失（=3）;血糖≥150（=2）;无tPA或血栓切除术（=1）; MLS >0-3（=1）、3-6（=2）、6-9（=4）; >9（=7）;既往无卒中（=1）。得分超过7与93%的阳性预测值相关。水肿评分识别PLME高风险患者。虽然它需要外部验证，但该量表可以帮助加快该患者人群的分流决策。
Rapid recognition of those at high-risk for malignant edema after stroke would facilitate triage for monitoring and potential surgery. Admission data may be insufficient for accurate triage decisions. We developed a risk prediction score using clinical and radiographic variables within 24 hours of ictus to better predict potentially lethal malignant edema (PLME). Patients admitted with diagnosis codes of “Cerebral Edema” and “Ischemic Stroke,” NIHSS ≥ 8, and head CTs within 24 hours of stroke-onset were included. Primary outcome of PLME was defined as death with midline shift (MLS) ≥ 5mm or Decompressive Hemicraniectomy. We performed multivariate analyses on data available within 24 hours of ictus. Bootstrapping was used to internally validate the model and a risk score was constructed from the results. 33% of 222 patients developed PLME. The final model c-statistic was 0.76 (CI 0.68-0.82) in the derivation cohort, and 0.75 (0.72-0.77) in the bootstrapping validation sample. The EDEMA score was developed using the following independent predictors: Basal cistern effacement (=3); Glucose ≥150 (=2); No tPA or thrombectomy (=1), MLS >0-3 (=1), 3-6 (=2), 6-9 (=4); >9 (=7); No prior stroke (=1). A score over 7 was associated with 93% positive predictive value. The EDEMA score identifies patients at high risk for PLME. While it requires external validation, this scale could help expedite triage decisions in this patient population.