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Prospective validation of the ICH Score for 12-month functional outcome
J Claude Hemphill1, Mary Farrant, Terry A Neill
1Department of Neurology, University of California, San Francisco, USA. chemphill@sfgh.ucsf.edu
Insights
The ICH Score accurately predicts long-term functional outcomes in patients with acute intracerebral hemorrhage (ICH). Many patients show continued improvement in recovery for up to a year after the initial event.
Area of Science:
- Neurology
- Clinical Medicine
- Public Health
Background:
- The Intracerebral Hemorrhage (ICH) Score is widely used for predicting 30-day mortality after acute intracerebral hemorrhage.
- Its validation for long-term functional outcomes has been limited.
- Understanding long-term prognosis is crucial for patient management and recovery planning.
Purpose of the Study:
- To evaluate the accuracy of the ICH Score in stratifying patients based on 12-month functional outcomes.
- To analyze the recovery trajectory of patients during the first year post-ICH.
Main Methods:
- A prospective observational cohort study was conducted.
- Data included ICH Score components (GCS, hematoma volume, IVH, ICH origin, age) and clinical characteristics.
- Patients were assessed using the modified Rankin Scale (mRS) at multiple time points up to 12 months.
Main Results:
- The ICH Score effectively stratified patients regarding 12-month functional outcomes (p < 0.05).
- A significant portion of patients (39%) died during initial hospitalization.
- Patient improvement continued throughout the first year, with some late-onset disabilities or deaths.
Conclusions:
- The ICH Score demonstrates validity as a predictor of long-term functional outcome after acute intracerebral hemorrhage.
- Significant patient recovery can occur after hospital discharge, extending beyond six months post-ICH.
Background:
The ICH Score is a commonly used clinical grading scale for outcome after acute intracerebral hemorrhage (ICH) and has been validated for 30-day mortality, but not long-term functional outcome. The goals of this study were to assess whether the ICH Score accurately stratifies patients with regard to 12-month functional outcome and to further delineate the pace of recovery of patients during the first year post-ICH.
Methods:
We performed a prospective observational cohort study of all patients with acute ICH admitted to the emergency departments of San Francisco General Hospital and UCSF Medical Center from June 1, 2001, through May 31, 2004. Components of the ICH Score (admission Glasgow Coma Scale score, initial hematoma volume, presence of intraventricular hemorrhage, infratentorial ICH origin, and age) were recorded along with other clinical characteristics. Patients were then assessed with the modified Rankin Scale (mRS) at hospital discharge, 30 days, and 3, 6, and 12 months post-ICH.
Results:
Of 243 patients, 95 (39%) died during initial acute hospitalization. The ICH Score accurately stratified patients with regard to 12-month functional outcome for various dichotomous cutpoints along the mRS (p < 0.05). Many patients continued to improve across the first year, with a small number of patients becoming disabled or dying due to late events unrelated to the initial ICH.
Conclusions:
The ICH Score is a valid clinical grading scale for long-term functional outcome after acute intracerebral hemorrhage (ICH). Many ICH patients improve after hospital discharge and this improvement may continue even after 6 months post-ICH.