Development and validation of the Essen intracerebral hemorrhage score

¹ University of Duisburg, Germany
² University of Duisburg-Essen, Germany
³ University of Essen, Germany

^* To whom correspondence should be addressed. E-mail: stroke.med{at}uni-essen.de.

Accepted 5 December 2005

	Abstract

Background: Spontaneous intracerebral hemorrhage (ICH) accounts for the highest in-hospital mortality of all stroke types. Nevertheless, outcome is favorable in about 30% of patients. Only 1 model for the prediction of favorable outcome has been validated so far.

Methods: Inception cohorts were assessed on the National Institutes of Health Stroke Scale (NIH-SS) at admission and followed-up after 100 days. Based on previously validated clinical variables, we developed a simple clinical score to predict mortality and complete recovery (Barthel Index after 100 days 95) in 340 patients with acute intracerebral hemorrhage. Subscores for age (<60=0; 60-69=1; 70-79=2; 80=3), NIH-SS level of consciousness (alert=0; drowsy=1; stupor=2; coma=3), and NIH-SS total score (0-5=0; 6-10=1; 11-15=2; 16-20=3; >20 or coma=4) were combined into a prognostic scale with <3 predicting complete recovery and >7 predicting death. The score was subsequently validated in an external cohort of 371 patients.

Results: The Essen ICH score showed a high prognostic accuracy for complete recovery and death in both the development and validation cohort. For prediction of complete recovery on the Barthel Index after 100 days, the Essen ICH score was superior to the physicians& [prime] prognosis as well as 2 previously developed prognostic scores developed for a slightly modified outcome.

Conclusion: Our study provides an easy-to-use scale for outcome prediction following ICH. Its high positive predictive values for adverse outcomes and easy applicability render the Essen ICH score useful for individual prognostic indications or design of clinical studies. In contrast, physicians tended to predict outcome too pessimistically.

Keywords: NIH-SS, hemorrhage, outcome, prediction, prognosis

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