Published Online
on March 2, 2006

A more recent version of this article appeared on April 1, 2006

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Submitted on July 22, 2005
Revised on October 6, 2005
Accepted on October 11, 2005

Predicting Mortality in Spontaneous Intracerebral Hemorrhage. Can Modification to Original Score Improve the Prediction?

Daniel Agustin Godoy MD^*; Gustavo Piñero MD; and Mario Di Napoli MD

From the Neurointensive Care Unit (D.A.G.), Sanatorio Pasteur, Catamarca, Argentina; Intensive Care Unit (G.P.), Hospital Leonidas Lucero, Bahia Blanca, Buenos Aires, Argentina; Neurological Service (M.D.N.), San Camillo de Lellis General Hospital, Rieti, Italy; and Neurological Section (M.D.N.), SMDN Center for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona (L’Aquila), Italy.

^* To whom correspondence should be addressed. E-mail: dagodoytorres{at}yahoo.com.ar.

Background and Purpose--A clinical grading scale for intracerebral hemorrhage (ICH), formally ICH score, was recently developed showing to predict 30-day mortality in a simple and reliable manner. The aim of the present study was to validate the original ICH (oICH) score in an independent cohort of patients from a developing country assessing 30-day mortality and 6-month functional outcome and whether its modifications can improve prediction.

Methods--Consecutive patients admitted with acute ICH between January 1, 2003, and July 31, 2004, were prospectively included. oICH score was applied and 2 modified ICH (mICH) scores were created with the same variables, except localization, of the oICH score but with different cutoff values. Outcome was assessed as 30-day mortality and 6-month good outcome (Glasgow Outcome Scale [GOS] 4 to 5).

Results--A total of 153 patients were included during study period. Thirty-day mortality rate was 34.6% (n=53), and 59 patients (38.6%) had good functional outcome (GOS 4 to 5) at 6 months. The oICH and mICH scores predicted mortality equally well. According to Youden’s index (J), the oICH score was a reliable predictor for mortality (J=0.59) but less reliable for predicting good outcome (J=0.54). The mICH scores were equal in predicting mortality but better for predicting good outcome than the oICH score (J=0.60).

Conclusions--oICH score also confirms its validity in a socially and culturally different population. Modifications of oICH do not improve its 30-day mortality prediction but improve its ability to predict good functional outcome at 6 months.

Key words: intracerebral hemorrhage • outcome • prognosis • risk factors • sensitivity and specificity

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