Application of a scoring instrument to predict intracerebral hemorrhage and outcome after thrombolysis for acute ischemic stroke.

Dear Editor,

Despite risk of symptomatic intracerebral hemorrhage (ICH), thrombolytic therapy may improve patient outcomes in acute ischemic stroke.[14] We sought to determine if the hemorrhage after thrombolysis (HAT) score, a five-point scale used to predict risk of HAT, might be a useful decision-making tool in the community hospital setting [Table 1]. We reviewed all 39 patients who presented to our emergency department between March 2006 and October 2008 and received thrombolytics for acute stroke. Outcomes were determined by review of medical records and telephone contact with patients or family members. Outcome measures were ICH, mortality and mRS <2. The median age of patients was 72 (IQR 56-80), and median National Institutes of Health Stroke Scale (NIHSS) was 11 (IQR 6-17), of which 64% were female. Twelve patients (31%, 95%CI: 16-46%) developed ICH (mean NIHSS = 15). Six patients (15%, 95%CI: 4-27%) died (mean NIHSS = 19). The area under the receiver operating characteristic curve (AUC) measuring the ability of the HAT score to predict ICH was 0.66 (95%CI: 0.47-0.84). The AUC to predict mortality was 0.67 (95%CI: 0.43-0.91) and to predict favorable outcome after stroke (mRS <2) was 0.77 (95%CI: 0.62-0.91) [Figure 1]. Despite data being retrospectively gathered from a single hospital emergency department, valuable information was nonetheless observed. The HAT score performed marginally well in predicting a favorable outcome after acute ischemic stroke, perhaps providing an additional risk stratification tool when considering thrombolytic therapy.[235]

Table 1

Hemorrhage after thrombolysis score scale

Figure 1

Area under receiver operating characteristic curve for favorable outcome (mRS <2)