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BMJ Open. 2018 Aug 13;8(8):e021719. doi: 10.1136/bmjopen-2018-021719.

Validation of the ICH score in patients with spontaneous intracerebral haemorrhage admitted to the intensive care unit in Southern Spain.

Author information

1
Intensive Care Medicine, Hospital de la Serranía, Ronda, Spain.
2
Programa de Doctorado, Universidad de Granada, Granada, Spain.
3
Intensive Care Medicine, Hospital Virgen de las Nieves, Granada, Spain.
4
Neurosurgery Department, Hospital del Mar, Barcelona, Spain.
5
Intensive Care Medicine, Hospital Infanta Margarita, Cabra, Spain.
6
Intensive Care Medicine, Hospital Carlos Haya, Málaga, Spain.
7
Cardiology Department, Hospital Virgen de las Nieves, Granada, Spain.
8
Neurosurgery Department, Hospital Carlos Haya, Málaga, Spain.
9
Intensive Care Medicine, Complejo Hospitalario de Jaén, Jaén, Spain.

Abstract

OBJECTIVE:

Validation of the intracerebral haemorrhage (ICH) score in patients with a diagnosis of spontaneous ICH admitted to the intensive care unit (ICU).

METHODS:

A multicentre cohort study was conducted in all consecutive patients with ICH admitted to the ICUs of three hospitals with a neurosurgery department between 2009 and 2012 in Andalusia, Spain. Data collected included ICH, Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores. Demographic data, location and volume of haematoma and 30-day mortality rate were also collated.

RESULTS:

A total of 336 patients were included. 105 of whom underwent surgery. Median (IQR) age: 62 (50-70) years.

APACHE-II:

21(15-26) points, GCS: 7 (4-11) points, ICH score: 2 (2-3) points. 11.1% presented with bilateral mydriasis on admission (mortality rate=100%). Intraventricular haemorrhage was observed in 58.9% of patients. In-hospital mortality was 54.17% while the APACHE-II predicted mortality was 57.22% with a standardised mortality ratio (SMR) of 0.95 (95% CI 0.81 to 1.09) and a Hosmer-Lemenshow test value (H) of 3.62 (no significant statistical difference, n.s.). 30-day mortality was 52.38% compared with the ICH score predicted mortality of 48.79%, SMR: 1.07 (95% CI 0.91 to 1.23), n.s. Mortality was higher than predicted at the lowest scores and lower than predicted in the more severe patients, (H=55.89, p<0.001), Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva calibration belt (p<0.001). The area under a receiver operating characteristic (ROC) curve was 0.74 (95% CI 0.69 to 0.79).

CONCLUSIONS:

ICH score shows an acceptable discrimination as a tool to predict mortality rates in patients with spontaneous ICH admitted to the ICU, but its calibration is suboptimal.

KEYWORDS:

ICH score; ICU; intracerebral haemorrhage; mortality; prognostic model

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