Frederik Geisler1, Medschid Wesirow2, Martin Ebinger3, Alexander Kunz3, Michal Rozanski4, Carolin Waldschmidt5, Joachim E Weber2, Matthias Wendt6, Benjamin Winter7, Heinrich J Audebert2,8. 1. Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. Frederik.Geisler@charite.de. 2. Department of Neurology, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. 3. Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany. 4. Department of Neurology, Auguste-Viktoria-Klinikum, Berlin, Germany. 5. Department of Neurology, Humboldt-Klinikum, Berlin, Germany. 6. Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany. 7. Department of Neurology, St. Josefs-Krankenhaus, Potsdam, Germany. 8. Center for Stroke Research Berlin, Berlin, Germany.
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.
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.
Entities:
Keywords:
Emergency medical services; Intracerebral hemorrhage; Ischemic stroke; Mobile stroke unit; Vascular neurology
Authors: Alexander Kunz; Martin Ebinger; Frederik Geisler; Michal Rozanski; Carolin Waldschmidt; Joachim E Weber; Matthias Wendt; Benjamin Winter; Katja Zieschang; Jochen B Fiebach; Kersten Villringer; Hebun Erdur; Jan F Scheitz; Serdar Tütüncü; Kerstin Bollweg; Ulrike Grittner; Sabina Kaczmarek; Matthias Endres; Christian H Nolte; Heinrich J Audebert Journal: Lancet Neurol Date: 2016-07-16 Impact factor: 44.182
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Authors: Ahmed Itrat; Ather Taqui; Russell Cerejo; Farren Briggs; Sung-Min Cho; Natalie Organek; Andrew P Reimer; Stacey Winners; Peter Rasmussen; Muhammad S Hussain; Ken Uchino Journal: JAMA Neurol Date: 2016-02 Impact factor: 18.302
Authors: Frederik Geisler; Syed F Ali; Martin Ebinger; Alexander Kunz; Michal Rozanski; Carolin Waldschmidt; Joachim E Weber; Matthias Wendt; Benjamin Winter; Lee H Schwamm; Heinrich J Audebert Journal: Int J Stroke Date: 2018-10-10 Impact factor: 5.266