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Published on: February 5, 2011
The DASH score: a simple score to assess risk for development of malignant middle cerebral artery infarction
Takashi Shimoyama1, Kazumi Kimura1, Junichi Uemura1
1Department of Stroke Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki City, Okayama 701-0192, Japan.
Background And Purpose:
The aim of the present study was to devise a simple grading scale for assessing the risk of development of malignant MCA infarction (MMI).
Methods:
Using MRI, patients with MCA infarction and proximal vessel occlusion (ICA or M1) within 24h of onset were retrospectively studied. MMI was defined as clinical deterioration, midline shift ≥ 5 mm, or brain herniation within 48 h of admission. We evaluated clinical factors independently associated with MMI and created a simple score according to the multivariate logistic regression analysis.
Results:
Subjects comprised 119 patients, 57 of which (47.9%) developed MMI. Multivariate logistic regression analysis revealed the following independent factors associated with MMI: DWI ASPECTS ≤ 3 [odds ratio (OR), 4.16; 95% CI, 1.36-12.66, P=0.012], ACA territory involvement [OR, 6.90; 95% confidence interval [CI], 2.06-23.10, P=0.002], M1 susceptibility vessel sign (SVS) on T2*-gradient echo [OR, 4.55; 95% CI, 1.38-14.98, P=0.013], and hyperglycemia (glucose value ≥ 145 mg/dl) [OR, 5.31; 95% CI, 1.80-15.68, P=0.002]. These four variables were selected for use in the DASH score, with DWI ASPECTS ≤ 3 as 1 point, ACA territory involvement as 1 point, M1 SVS as 1 point, and hyperglycemia as 1 point. The likelihood of developing MMI for each score was as follows: score 0, 9.1%; score 1, 20.5%; score 2, 63.0%; score 3-4, 96.8%. The C statistic for the score was 0.88 (95% CI, 0.82-0.94, P<0.001).
Conclusion:
Our DASH score reliably assessed a risk for development of MMI in large MCA infarctions.
Insights
A new DASH score effectively predicts malignant MCA infarction (MMI) risk in large MCA infarctions. This simple grading scale uses DWI ASPECTS, ACA territory involvement, M1 SVS, and hyperglycemia to assess MMI development.
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Malignant Middle Cerebral Artery (MCA) Infarction (MMI) poses a significant risk for neurological deterioration and mortality.
- Accurate risk assessment is crucial for timely intervention in patients with large MCA infarctions.
Purpose of the Study:
- To develop a simple grading scale for predicting the risk of malignant MCA infarction (MMI).
- To identify independent clinical and radiological factors associated with MMI development.
Main Methods:
- Retrospective analysis of 119 patients with MCA infarction and proximal vessel occlusion within 24 hours of onset.
- MRI including DWI and T2*-gradient echo sequences were used.
- Multivariate logistic regression identified independent predictors of MMI, defined by clinical deterioration, midline shift, or herniation within 48 hours.
Main Results:
- The study identified four independent predictors of MMI: DWI ASPECTS ≤ 3, ACA territory involvement, M1 susceptibility vessel sign (SVS), and hyperglycemia (glucose ≥ 145 mg/dl).
- These factors were incorporated into the DASH score. The likelihood of MMI increased significantly with higher scores (9.1% for score 0 to 96.8% for score 3-4).
- The DASH score demonstrated excellent predictive accuracy with a C-statistic of 0.88.
Conclusions:
- The developed DASH score reliably assesses the risk of malignant MCA infarction in patients with large MCA infarctions.
- This simple grading scale can aid clinicians in identifying high-risk patients who may benefit from closer monitoring or early intervention.
