Patients who were transferred from another hospital were excluded in order to ensure availability of records related to initial evaluation and to exclude potential differential bias if transferred patients had different characteristics than those presenting directly to the ED for initial evaluation. We performed a prospective longitudinal observational study involving all patients with acute nontraumatic intracerebral hemorrhage who presented to the emergency departments (ED) of San Francisco General Hospital (SFGH) or UCSF Medical Center from June 1, 2001, through May 31, 2004. In order to accomplish these aims, we conducted a prospective study of acute ICH patients who were then followed for outcome for 12 months. A final goal was to provide insight into the pace of recovery of ICH survivors, in order to assess the optimal time point during the first year for the purposes of outcome assessment. ![]() Given recent concerns that early care limitations such as early do-not-resuscitate orders or withdrawal of medical support may create self-fulfilling prophecies of poor outcome, 18–20 an additional aim was to determine whether this influenced the reliability of the ICH Score on risk stratification. The overall purpose of this study was to determine whether the ICH Score reliably stratifies patients with acute ICH with regard to 12-month functional outcome as assessed by the modified Rankin Scale (mRS). ![]() Just as the use of clinical grading scales has improved communication and consistency in other neurocritical care disorders such as acute ischemic stroke (NIH Stroke Scale), traumatic brain injury (Glasgow Coma Scale), and subarachnoid hemorrhage (Hunt/Hess and World Federation of Neurological Surgeons Scales), the availability of a validated reliable grading scale which is predictive of both early mortality and long-term functional outcome would likely improve consistency in ICH. Numerous observational studies have been performed to develop prediction models and scales for ICH outcome, 2,6,10–17 although few besides the ICH Score have been externally validated. Even so, there remains great interest in understanding and using outcome predictors for ICH. 7 However, the reliability of the ICH Score in stratifying patients regarding long-term functional outcome has not been systematically assessed.ĭespite several recent large clinical trials of medical or surgical interventions, 8,9 ICH remains without a treatment of proven benefit. The ICH Score has subsequently been externally validated in numerous other cohorts 2–6 and has been used as a stratification tool in a clinical trial of neuroprotection in order to improve balance of baseline characteristics. Outcome for development of the ICH Score was mortality at 30 days. 1 Comprised of factors related to age, initial level of consciousness, and neuroimaging findings, the ICH Score was initially developed to provide a simple, reliable way of stratifying outcome early after acute ICH for the purpose of improving communication for clinical care and clinical research. ![]() The ICH Score is the most commonly used clinical grading scale for outcome after intracerebral hemorrhage (ICH).
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