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ICH Score predicts long-term functional outcome after acute ICH

Clinical Question:
Can clinical and radiologic data predict long-term outcomes after acute intracranial hemorrhage?

Bottom Line:
Patients suffering an acute intracranial hemorrhage (ICH) with low ICH Scores are more likely to have favorable functional outcomes 12 months later. (LOE = 1b)

Hemphill JC 3rd, Farrant M, Neill TA Jr. Prospective validation of the ICH Score for 12-month functional outcome. Neurology 2009;73(14):1088-1094.  [PMID:19726752]

Study Design:
Decision rule (validation)

Inpatient (any location) with outpatient follow-up

These authors evaluated 243 consecutive patients with acute ICH and followed them for up to 12 months. Each patient underwent a standardized clinical and radiologic assessment, including the calculation of their ICH Score. The ICH Score is a summary score (range = 0 - 5) based on the a sum of the following: Glasgow Coma Score (3 - 4 = 2 points; 5 - 12 = 1 point; 13 - 15 = 0 points), hematoma volume (30 mL or more = 1 point; < 30 mL = 0 points), intraventricular hemorrhage (present = 1 point; absent = 0), infratentorial origin (yes = 1; no = 0), and patient age (80 years or older = 1; younger than 80 years = 0). The main outcome measure -- functional status -- was measured using the modified Rankin Scale, which runs from 0 to 6, with 6 being death, 5 severe disability, and so on. The patients were evaluated directly by the research staff. If the staff was unable to contact the patient, they reviewed medical records and searched the Social Security Death Registry. Of the initial 243 patients, 39% died during the initial hospitalization. Because each of these scales are not continuous and not normally distributed, the authors properly evaluated each combination of scores and cut-offs, finding that the ICH Score correlated well with the modified Rankin Scale at 12 months.


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