학술논문
Probability assessment of intracerebral hemorrhage in prehospital emergency patients.
Document Type
Academic Journal
Author
Geisler F; Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. Frederik.Geisler@charite.de.; Wesirow M; Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.; Ebinger M; Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany.; Kunz A; Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany.; Rozanski M; Department of Neurology, Auguste-Viktoria-Klinikum, Berlin, Germany.; Waldschmidt C; Department of Neurology, Humboldt-Klinikum, Berlin, Germany.; Weber JE; Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.; Wendt M; Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany.; Winter B; Department of Neurology, St. Josefs-Krankenhaus, Potsdam, Germany.; Audebert HJ; Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.; Center for Stroke Research Berlin, Berlin, Germany.
Source
Publisher: BMC Country of Publication: England NLM ID: 101767802 Publication Model: Electronic Cited Medium: Internet ISSN: 2524-3489 (Electronic) Linking ISSN: 25243489 NLM ISO Abbreviation: Neurol Res Pract Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Background: Routing of patients with intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) to the most appropriate hospital is challenging for emergency medical services particularly when specific treatment options are only provided by specialized hospitals and determination of the exact diagnosis is difficult. We aimed to develop a prehospital score - called prehospital-intracerebral hemorrhage score (ph-ICH score) - to assist in discriminating between both conditions.
Methods: The ph-ICH score was developed with data from patients treated aboard a mobile stroke unit in Berlin, Germany, between 2011 and 2013 (derivation cohort) and in 2018 (validation cohort). Diagnosis of ICH or AIS was established using clinical data and neuroradiological cerebral imaging. Diagnostic accuracy was measured with significance testing, Cohen's d and receiver-operating-characteristics.
Results: We analyzed 416 patients (32 ICH, 224 AIS, 41 transient ischemic attack, 119 stroke mimic) in the derivation cohort and 285 patients (33 ICH and 252 AIS) in the validation cohort. Systolic blood pressure, level of consciousness and severity of neurological deficits (i. e. certain items of the National Institutes of Health Stroke Scale) were used to calculate the ph-ICH score that showed higher values in the ICH compared to the AIS group (derivation cohort: 1.8 ± 1.2 vs. 1.0 ± 0.9 points; validation cohort: 1.8 ± 0.9 vs. 0.8 ± 0.7 points; d = 0.9 and 1.4, both p < 0.01). Receiver-operating-characteristics showed fair and good accuracy with an area under the curve of 0.71 for the derivation and 0.81 for the validation cohort.
Conclusions: The ph-ICH score can assist medical personnel in the field to assess the likelihood of ICH and AIS in emergency patients.
Methods: The ph-ICH score was developed with data from patients treated aboard a mobile stroke unit in Berlin, Germany, between 2011 and 2013 (derivation cohort) and in 2018 (validation cohort). Diagnosis of ICH or AIS was established using clinical data and neuroradiological cerebral imaging. Diagnostic accuracy was measured with significance testing, Cohen's d and receiver-operating-characteristics.
Results: We analyzed 416 patients (32 ICH, 224 AIS, 41 transient ischemic attack, 119 stroke mimic) in the derivation cohort and 285 patients (33 ICH and 252 AIS) in the validation cohort. Systolic blood pressure, level of consciousness and severity of neurological deficits (i. e. certain items of the National Institutes of Health Stroke Scale) were used to calculate the ph-ICH score that showed higher values in the ICH compared to the AIS group (derivation cohort: 1.8 ± 1.2 vs. 1.0 ± 0.9 points; validation cohort: 1.8 ± 0.9 vs. 0.8 ± 0.7 points; d = 0.9 and 1.4, both p < 0.01). Receiver-operating-characteristics showed fair and good accuracy with an area under the curve of 0.71 for the derivation and 0.81 for the validation cohort.
Conclusions: The ph-ICH score can assist medical personnel in the field to assess the likelihood of ICH and AIS in emergency patients.