A grading scale for surgically treated patients with spontaneous supratentorial intracerebral hemorrhage: the Surgical Swedish ICH Score

View More View Less
  • 1 Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, Uppsala;
  • 2 Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund;
  • 3 Department of Neuroscience, Karolinska Institutet;
  • 4 Department of Medicine and Clinical Neuroscience, Neurosurgery, Karolinska Institutet, Karolinska University Hospital, Stockholm;
  • 6 Department of Clinical Neuroscience, Neurosurgery, University of Gothenburg, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg;
  • 7 Department of Clinical and Experimental Medicine, Neurosurgery, Linköping University, Linköping University Hospital, Linköping;
  • 8 Department of Clinical Neuroscience, Neurosurgery, Umeå University, Umeå University Hospital, Umeå, Sweden; and
  • 5 Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The authors aimed to develop the first clinical grading scale for patients with surgically treated spontaneous supratentorial intracerebral hemorrhage (ICH).

METHODS

A nationwide multicenter study including 401 ICH patients surgically treated by craniotomy and evacuation of a spontaneous supratentorial ICH was conducted between January 1, 2011, and December 31, 2015. All neurosurgical centers in Sweden were included. All medical records and neuroimaging studies were retrospectively reviewed. Independent predictors of 30-day mortality were identified by logistic regression. A risk stratification scale (the Surgical Swedish ICH [SwICH] Score) was developed using weighting of independent predictors based on strength of association.

RESULTS

Factors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score (p = 0.00015), ICH volume ≥ 50 mL (p = 0.031), patient age ≥ 75 years (p = 0.0056), prior myocardial infarction (MI) (p = 0.00081), and type 2 diabetes (p = 0.0093). The Surgical SwICH Score was the sum of individual points assigned as follows: GCS score 15–13 (0 points), 12–5 (1 point), 4–3 (2 points); age ≥ 75 years (1 point); ICH volume ≥ 50 mL (1 point); type 2 diabetes (1 point); prior MI (1 point). Each increase in the Surgical SwICH Score was associated with a progressively increased 30-day mortality (p = 0.0002). No patient with a Surgical SwICH Score of 0 died, whereas the 30-day mortality rates for patients with Surgical SwICH Scores of 1, 2, 3, and 4 were 5%, 12%, 31%, and 58%, respectively.

CONCLUSIONS

The Surgical SwICH Score is a predictor of 30-day mortality in patients treated surgically for spontaneous supratentorial ICH. External validation is needed to assess the predictive value as well as the generalizability of the Surgical SwICH Score.

ABBREVIATIONS AIC = Akaike information criterion; GCS = Glasgow Coma Scale; ICH = intracerebral hemorrhage; IVH = intraventricular hemorrhage; MI = myocardial infarction; NOAC = non–vitamin K antagonist oral anticoagulant; Surgical SwICH Score = Surgical Swedish ICH Score; VKA = vitamin K antagonist.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Niklas Marklund: Lund University, Skane University Hospital, Lund, Sweden. niklas.marklund@med.lu.se.

INCLUDE WHEN CITING Published online August 23, 2019; DOI: 10.3171/2019.5.JNS19622.

Disclosures This work has been supported by ALF funds from Uppsala University Hospital and Region Östergötland. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • 1

    Akaike H: A new look at the statistical model identification. IEEE Trans Automat Contr 19:716723, 1974

  • 2

    Ariesen MJ, Claus SP, Rinkel GJ, Algra A: Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 34:20602065, 2003

    • Search Google Scholar
    • Export Citation
  • 3

    Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, : Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 38:20012023, 2007

    • Search Google Scholar
    • Export Citation
  • 4

    Broderick JP, Brott T, Tomsick T, Miller R, Huster G: Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 78:188191, 1993

    • Search Google Scholar
    • Export Citation
  • 5

    Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, : Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864870, 1989

    • Search Google Scholar
    • Export Citation
  • 6

    Burnham KP, Anderson DR: Multimodel inference: understanding AIC and BIC in model selection. Sociol Methods Res 33:261304, 2004

  • 7

    Clarke JL, Johnston SC, Farrant M, Bernstein R, Tong D, Hemphill JC III: External validation of the ICH score. Neurocrit Care 1:5360, 2004

    • Search Google Scholar
    • Export Citation
  • 8

    Counsell C, Boonyakarnkul S, Dennis M, Sandercock P, Bamford J, Burn J, : Primary intracerebral haemorrhage in the Oxfordshire Community Stroke Project, 2: prognosis. Cerebrovasc Dis 5:2634, 1995

    • Search Google Scholar
    • Export Citation
  • 9

    Cuzick J: A Wilcoxon-type test for trend. Stat Med 4:8790, 1985

  • 10

    Doyle DJ, Garmon EH: American Society of Anesthesiologists Classification (ASA Class). StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing LLC, 2018 (https://www.ncbi.nlm.nih.gov/books/NBK441940/) [Accessed June 21, 2019]

    • Search Google Scholar
    • Export Citation
  • 11

    Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 8:355369, 2009

    • Search Google Scholar
    • Export Citation
  • 12

    Garrett JS, Zarghouni M, Layton KF, Graybeal D, Daoud YA: Validation of clinical prediction scores in patients with primary intracerebral hemorrhage. Neurocrit Care 19:329335, 2013

    • Search Google Scholar
    • Export Citation
  • 13

    Gregson BA, Broderick JP, Auer LM, Batjer H, Chen XC, Juvela S, : Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage. Stroke 43:14961504, 2012

    • Search Google Scholar
    • Export Citation
  • 14

    Grysiewicz RA, Thomas K, Pandey DK: Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurol Clin 26:871895, vii, 2008

    • Search Google Scholar
    • Export Citation
  • 15

    Hemphill JC III, Bonovich DC, Besmertis L, Manley GT, Johnston SC: The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 32:891897, 2001

    • Search Google Scholar
    • Export Citation
  • 16

    Hemphill JC III, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, : Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:20322060, 2015

    • Search Google Scholar
    • Export Citation
  • 17

    Hessington A, Tsitsopoulos PP, Fahlström A, Marklund N: Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage: a retrospective single-center analysis of 123 cases. Acta Neurochir (Wien) 160:17371747, 2018

    • Search Google Scholar
    • Export Citation
  • 18

    Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, : The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27:13041305, 1996

    • Search Google Scholar
    • Export Citation
  • 19

    LeRoux PD, Haglund MM, Newell DW, Grady MS, Winn HR: Intraventricular hemorrhage in blunt head trauma: an analysis of 43 cases. Neurosurgery 31:678685, 1992

    • Search Google Scholar
    • Export Citation
  • 20

    Mayer SA, Rincon F: Treatment of intracerebral haemorrhage. Lancet Neurol 4:662672, 2005

  • 21

    Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, : Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 365:387397, 2005

    • Search Google Scholar
    • Export Citation
  • 22

    Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM: Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 382:397408, 2013

    • Search Google Scholar
    • Export Citation
  • 23

    Parry-Jones AR, Abid KA, Di Napoli M, Smith CJ, Vail A, Patel HC, : Accuracy and clinical usefulness of intracerebral hemorrhage grading scores: a direct comparison in a UK population. Stroke 44:18401845, 2013

    • Search Google Scholar
    • Export Citation
  • 24

    Prasad K, Mendelow AD, Gregson B: Surgery for primary supratentorial intracerebral haemorrhage. Cochrane Database Syst Rev 4:CD000200, 2008

    • Search Google Scholar
    • Export Citation
  • 25

    Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg 68:985986, 1988

    • Search Google Scholar
    • Export Citation
  • 26

    Rincon F, Mayer SA: Intracerebral hemorrhage: getting ready for effective treatments. Curr Opin Neurol 23:5964, 2010

  • 27

    Sacco S, Marini C, Toni D, Olivieri L, Carolei A: Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke 40:394399, 2009

    • Search Google Scholar
    • Export Citation
  • 28

    Saposnik G, Cote R, Mamdani M, Raptis S, Thorpe KE, Fang J, : JURaSSiC: accuracy of clinician vs risk score prediction of ischemic stroke outcomes. Neurology 81:448455, 2013

    • Search Google Scholar
    • Export Citation
  • 29

    Satopää J, Mustanoja S, Meretoja A, Putaala J, Kaste M, Niemelä M, : Comparison of all 19 published prognostic scores for intracerebral hemorrhage. J Neurol Sci 379:103108, 2017

    • Search Google Scholar
    • Export Citation
  • 30

    Socialstyrelsen: Nationella Riktlinjer för Strokevård. 2018. (https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/nationella-riktlinjer/2018-3-11.pdf) [Accessed June 24, 2019]

    • Search Google Scholar
    • Export Citation
  • 31

    Steiner T, Al-Shahi Salman R, Beer R, Christensen H, Cordonnier C, Csiba L, : European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 9:840855, 2014

    • Search Google Scholar
    • Export Citation
  • 32

    Steiner T, Kaste M, Forsting M, Mendelow D, Kwiecinski H, Szikora I, : Recommendations for the management of intracranial haemorrhage—part I: spontaneous intracerebral haemorrhage. Cerebrovasc Dis 22:294316, 2006 (Erratum in Cerebrovasc Dis 22:461, 2006)

    • Search Google Scholar
    • Export Citation
  • 33

    Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:8184, 1974

  • 34

    Toyoda K, Steiner T, Epple C, Kern R, Nagayama M, Shinohara Y, : Comparison of the European and Japanese guidelines for the acute management of intracerebral hemorrhage. Cerebrovasc Dis 35:419429, 2013

    • Search Google Scholar
    • Export Citation
  • 35

    van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ: Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 9:167176, 2010

    • Search Google Scholar
    • Export Citation
  • 36

    Vanneste J, Augustijn P, Tan WF, Dirven C: Shunting normal pressure hydrocephalus: the predictive value of combined clinical and CT data. J Neurol Neurosurg Psychiatry 56:251256, 1993

    • Search Google Scholar
    • Export Citation
  • 37

    Zahuranec DB, Morgenstern LB, Sánchez BN, Resnicow K, White DB, Hemphill JC III: Do-not-resuscitate orders and predictive models after intracerebral hemorrhage. Neurology 75:626633, 2010

    • Search Google Scholar
    • Export Citation
  • 38

    Zia E, Engström G, Svensson PJ, Norrving B, Pessah-Rasmussen H: Three-year survival and stroke recurrence rates in patients with primary intracerebral hemorrhage. Stroke 40:35673573, 2009

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 100 100 100
Full Text Views 54 54 54
PDF Downloads 37 37 37
EPUB Downloads 0 0 0