A Comparison of the Intracerebral Hemorrhage Score and the Acute Physiology and Chronic Health Evaluation II Score for 30-Day Mortality Prediction in Spontaneous Intracerebral Hemorrhage.

The intracerebral hemorrhage (ICH) score is well established as a reliable prognostic score in ICH, whereas recently, Acute Physiology and Chronic Health Evaluation II (APACHE II) has been observed to have a better discrimination in predicting mortality in primary pontine hemorrhage. Further, physiological parameters of APACHE II have been associated with outcome in ICH. This study is the first to observe a direct comparison between APACHE II and ICH scores in predicting 30-day mortality in spontaneous intracerebral hemorrhage (SICH). This study was a prospective observational study where we compared the receiver operating characteristic (ROCs) of baseline ICH and APACHE II scores in patients with SICH for predicting 30-day mortality outcome. We observed that both APACHE II and ICH scores were good for predicting 30-day mortality with both having an area under the ROC curve of more than .8 (.831 [95% confidence interval {CI}, .740-.922; P <.001] and .892 [95% CI, .757-.932; P <.001], respectively). However, the ICH score was better discriminative (area under the curve AUC, .892 versus .831; P = .040) and better calibrated (P = .037 versus P = .089, Hosmer-Lemeshow goodness-of-fit test for logistic regression) for the same. Both APACHE II and ICH scores had a sensitivity of 87% at cutoff values of 19 and 3, respectively; however, the ICH score had a better specificity (90% versus 76.5%). The ICH score was observed to have a better discrimination and calibration for predicting 30-day mortality in SICH.

Pan K ，Panwar A ，Roy U ，Das BK ... -  《-》

Validation of Prognostic Models to Predict Early Mortality in Spontaneous Intracerebral Hemorrhage: A Cross-Sectional Evaluation of a Singapore Stroke Database.

Numerous scores have been developed for prognostication of outcomes in intracerebral hemorrhage (ICH). Prediction models must be validated internally and externally before they are considered widely applicable. We aim to independently externally validate and compare 3 prediction models (ICH score, ICH grading scale [ICH-GS], and simplified ICH [sICH]) in our population, which has not been previously done. We reviewed 1338 patients with spontaneous ICH consecutively admitted to the National Neuroscience Institute, Singapore, between January 2009 and November 2013. We analyzed prospectively collected data of admission characteristics (clinical, neuroimaging, and laboratory findings). All 3 scores prognosticated 30-day mortality. Validation was based on calibration, goodness-of-fit tests, and discrimination (area under receiver operating characteristic curve [AUC]). Akaike information criterion (AIC) and decision curve analysis (DCA) were used to directly compare the scores. All 3 models showed good calibration and both the Hosmer-Lemeshow and the le Cessie-van Houwelingen-Copas goodness-of-fit test showed P values >0.05. AUCs ranged from 0.86 to 0.90, indicating good discriminative ability, with the ICH-GS performing the best with the highest AUC, lowest AIC (849), and overall highest net benefit in the DCA. This study successfully independently validates the ICH score, ICH-GS, and sICH score in a large patient cohort with spontaneous ICH, which has not been previously done in this non-Western population. We recommend the use of the ICH-GS as a prognostication tool in our patients instead of the widely used ICH score.

Han JX ，See AAQ ，King NKK 《-》

Common intensive care scoring systems do not outperform age and glasgow coma scale score in predicting mid-term mortality in patients with spontaneous intracerebral hemorrhage treated in the intensive care unit.

Fallenius M ，Skrifvars MB ，Reinikainen M ，Bendel S ，Raj R ... -  《Scandinavian Journal of Trauma Resuscitation & Emergency Medicine》

Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage.

Cheung RT ，Zou LY 《-》

The prediction of 30-day mortality in patients with primary pontine hemorrhage: a scoring system comparison.

Owing to its low morbidity but high mortality, no accurate scoring system focuses on primary pontine hemorrhage (PPH) has been established. We aim to compare the performances of the Acute Physiology and Chronic Health Evaluation (APACHE) II and the Simplified Acute Physiology Score (SAPS) II with the ICH score in predicting the 30-day mortality in patients with PPH. We conducted a retrospective analysis of patients admitted with a diagnosis of PPH to a university-affiliated hospital in southern China from May 2000 to June 2011. Data related to patient demographics and that necessary to calculate APACHE II, SAPS II, and ICH score were recorded. Performances of these scoring systems were presented as calibration and discrimination, which were measured by the Hosmer-Lemeshow goodness-of-fit test and the area under the receiver operating characteristic (ROC) curve, respectively. Among 75 patients with PPH finally included, 31 (41.3%) died within 30 days. SAPS II (χ(2) = 6.57, P = 0.682) had the best calibration, followed by APACHE II (χ(2) = 8.06, P = 0.428) and ICH score (χ(2) = 4.94, P = 0.176). Furthermore, in terms of area under the ROC curve, APACHE II (0.919) was more discriminative than SAPS II (0.890) and ICH score (0.844). In predicting 30-day mortality in patients with PPH, SAPS II has the best calibration, while APACHE II has the highest discrimination. The ICH score, which is easier and simpler to calculate, should be modified for PPH.

Huang KB ，Ji Z ，Wu YM ，Wang SN ，Lin ZZ ，Pan SY ... -  《-》