Introduction: The 2015 AHA/ASA guidelines recommend documentation of a stroke severity scale in the initial evaluation for intracerebral hemorrhage (ICH) patients. We describe the distribution of three stroke severity scores and their association with 30 day mortality within a population.
Methods: We identified all ICH patients ≥ 20 years old in 2010 among residents of the Greater Cincinnati/Northern Kentucky region, a biracial population of ∼1.3 million. We screened area hospitals’ discharge ICD-9 codes for potential cases. Study nurses abstracted relevant information from hospital charts, and study physicians verified the cases of ICH. Data included NIH stroke scale determined retrospectively (rNIHSS) (range of scores (0-42), Glasgow coma scale (GCS) (0-15), and ICH score (0-6). Cases whose rNIHSS could not be evaluated due to coma were assigned a score of 35. Multiple logistic regression was used to examine association with mortality.
Results: There were 304 ICH patients with ICH scores available. Mean (±SD) age was 69 (±16) years, 160 (53%) were female, and 76 (25%) were black. Median (IQR) values for the severity scores were rNIHSS 7 (1, 22), GCS 14 (9, 15), and ICH score 2 (1, 3) (Figure). Models that examined the scales individually and controlled for age, sex, and race showed odds ratios (OR) (95% CI) for 30 day mortality of 1.5 (1.2, 1.9) for each 5 point increase in rNIHSS, 1.5 (1.4, 1.6) for each 1 point decrease in GCS, and 4.59 (3.34, 6.64) for each 1 point increase in ICH score. With both rNIHSS and ICH score in the same model there was an increased odds of 30 day mortality of 1.5 (1.3, 2.0) for each 5 point increase in rNIHSS and increased odds of 2.8 (1.9, 4.0) for each one point increase in ICH score independently.
Conclusion: We found that the rNIHSS in combination with ICH score provides additional predictive information with regard to 30 day mortality, and we recommend further prospective study for validation.