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J Clin Neurol. 2015 Oct;11(4):339-48. doi: 10.3988/jcn.2015.11.4.339. Epub 2015 Aug 6.

Prognostic Tools for Early Mortality in Hemorrhagic Stroke: Systematic Review and Meta-Analysis.

Author information

1
Health Evidence Synthesis Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
2
Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.
3
Department of Elderly Medicine, Southend University Hospital Trust, Westcliff-on-Sea, Essex, UK.
4
Epidemiology Group, Institute of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland, UK.
5
Health Evidence Synthesis Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK. y.loke@uea.ac.uk.

Abstract

BACKGROUND AND PURPOSE:

Several risk scores have been developed to predict mortality in intracerebral hemorrhage (ICH). We aimed to systematically determine the performance of published prognostic tools.

METHODS:

We searched MEDLINE and EMBASE for prognostic models (published between 2004 and April 2014) used in predicting early mortality (<6 months) after ICH. We evaluated the discrimination performance of the tools through a random-effects meta-analysis of the area under the receiver operating characteristic curve (AUC) or c-statistic. We evaluated the following components of the study validity: study design, collection of prognostic variables, treatment pathways, and missing data.

RESULTS:

We identified 11 articles (involving 41,555 patients) reporting on the accuracy of 12 different tools for predicting mortality in ICH. Most studies were either retrospective or post-hoc analyses of prospectively collected data; all but one produced validation data. The Hemphill-ICH score had the largest number of validation cohorts (9 studies involving 3,819 patients) within our systematic review and showed good performance in 4 countries, with a pooled AUC of 0.80 [95% confidence interval (CI)=0.77-0.85]. We identified several modified versions of the Hemphill-ICH score, with the ICH-Grading Scale (GS) score appearing to be the most promising variant, with a pooled AUC across four studies of 0.87 (95% CI=0.84-0.90). Subgroup testing found statistically significant differences between the AUCs obtained in studies involving Hemphill-ICH and ICH-GS scores (p=0.01).

CONCLUSIONS:

Our meta-analysis evaluated the performance of 12 ICH prognostic tools and found greater supporting evidence for 2 models (Hemphill-ICH and ICH-GS), with generally good performance overall.

KEYWORDS:

mortality; prognostic scores; risk prediction model; stroke

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