A Comparative Evaluation Of Three Grading Scales In Intracerebral Hemorrhage

Objective:Intracerebral hemorrhage refers to the non traumatic parenchymal hemorrhage which is of extremely high mortality and morbidity.the early and effective evaluation of clinical outcomes for patients with cerebral hemorrhage,is important for the guidance of clinical treatment.For a decade,various prognostic score systems have been devised and tested to predict short-term mortality,long-term mortality and Functional outcome after intracerebral hemorrhage,but none has been used routinely in clinical practice.This article will study three scales namely oICH scale(the original ICH score),ICH-GS scale(ICH grading scale)and ICH-FOS score(ICH Functional Outcome score)in evaluating 30-day mortality and 3-months of poor outcome,and comparing the accuracy of three scores,then use the most accurate ICH scale to evaluate clinical outcomes in patients and screen high-risk patients with poor prognosis,positive and reasonable clinical intervention will be used to reduce mortality or improve Functional outcomes of patients.Methods:1.Use prospective and observational clinical study,the patients are derived from the Neurology intensive care units of the Fist Hospital of Dalian Medical University between January 2014 and December 2015.Record the clinical features of patients on admission,such as age,gender,history of stroke,history of hypertension,diabetes,intracerebral hemorrhage volume,Hematoma location,intraventricular extension,GCS score,NIHSS score,blood sugar levels.Use the oICH scale,ICH-GS scale and ICH-FOS score to score the patients on admission.and record the survival of 30 days and poor outcome of 3 months of the ICH patients(m RS score?3 means poor outcome).2.Use SPSS19 statistical analysis,P < 0.05 means the difference was statistically significant.The t test,Mann-Whitney U test and chi-square test is used on the variable.Binary logistic regression model is used to judge the factors of 30-day mortality and functional outcome of 3 months.3.Draw the receiver-operating characteristics of 30-day mortality and poor functional outcomes of 3 months,it is concluded that the area under the curve(Au ROC),the maximum Youden Index,the best diagnostic point,sensitivity,specificity,positive predictive value and negative predictive value.Compare three scale in evaluating ICH patients death ending 30 days and 3 months functional outcome the accuracy of the bad aspects.Results:1.121 patients have participated in this study,in the case,30-day mortality rate was 32%(n = 39),the rate of poor functional outcome is 55%(n = 67).Statistical analysis results show that the factors that affect the 30-day mortality are age,GCS score,NIHSS score,hematoma volume,intraventricular extension,blood sugar on admission.Factors that affect poor functional outcome of 3 months are age,GCS score,NIHSS score,hematoma volume,intraventricular extension.2.When we use oICH scale,ICH-GS scale,ICH-FOS scale to evaluate 30 days mortality and 3 months poor functional outcome of ICH patients,the higher of the score,the higher of the rate,and more than or equal to 3 points,8 points,8 points respectively,the rate of 30 days mortality and 3 months poor functional outcome were significantly increased.3.The ROC curve of 30 days mortality shows the Au ROC,of oICH scale,ICH-GS scale,ICH-FOS scale are:0.911,0.920,0.948;the ROC curve of 3 months poor functional outcome shows the Au ROC,of oICH scale,ICH-GS scale,ICH-FOS scale are:0.822,0.836,0.841.ICH-FOS scale has a best accuracy both in evaluating the 30 days mortality and 3 months poor functional outcome.Conclusion:1.All of the oICH scale,ICH-GS scale,ICH-FOS scale can evaluate ICH 30-day mortality and poor functional outcome of 3 months in patients,but the ICH-FOS scale is the best one,and its clinical application is more suitable for the Chinese.2.When evaluating the mortality of 30 days and the poor function of 3 months in patients by ICH-FOS scale in patients,more than 8point,the rate of death and poor functional outcomes is high.