Huili Kang1, Qiuqiong Cai1, Liang Gong2, Ying Wang1. 1. Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, People's Republic of China. 2. Department of Neurosurgery, Shanghai Punan Hospital of Pudong New District, Shanghai, People's Republic of China.
Abstract
BACKGROUND: The early symptoms of patients with elevated intracranial pressure (ICP) after intracerebral hemorrhage (ICH) are easily overlooked, which will result in missing the optimal opportunity for clinical intervention. However, it is difficult for ICH patients admitted to the neurology department to receive invasive ICP monitoring, although it is crucial for the early identification of neurologic deterioration (ND). OBJECTIVE: The aim of this study is to investigate the association between the changes of transcranial Doppler (TCD) variables and ND after onset and establish a nomogram for predicting the short-term outcome of ICH. METHODS: A total of 297 patients were recruited and their clinical characteristics and the changes of TCD variables were recorded. The independent prognostic factors for the ND after onset in the ICH patients were screened from multivariate Logistic regression analysis, which were served as inputs for the nomogram construction. Discrimination and calibration validations were performed to assess the performance of the nomogram [concordance index (C-index) for discrimination and Hosmer-Lemeshow (HL) test for calibration] and the decision curve analysis was applied to assess the clinical suitability. RESULTS: ΔaPI [defined as the change of pulsatility index (PI) between the 1st and 3rd day after onset for affected hemisphere] was independently associated with the ND after onset. Moreover, hematoma volume, presence of intraventricular hemorrhage, and Glasgow coma scale were also the independent prognostic factors of ND. The developed nomogram incorporating ΔaPI showed good discrimination (C-index: 0.916 after 1000 bootstrapping) and calibration (P=0.412, HL test) and yielded net benefits. CONCLUSION: The nomogram incorporating ΔaPI might be useful in predicting the risk of ND within 14 days after onset, which might help identify patients in the neurology department in need of further care.
BACKGROUND: The early symptoms of patients with elevated intracranial pressure (ICP) after intracerebral hemorrhage (ICH) are easily overlooked, which will result in missing the optimal opportunity for clinical intervention. However, it is difficult for ICH patients admitted to the neurology department to receive invasive ICP monitoring, although it is crucial for the early identification of neurologic deterioration (ND). OBJECTIVE: The aim of this study is to investigate the association between the changes of transcranial Doppler (TCD) variables and ND after onset and establish a nomogram for predicting the short-term outcome of ICH. METHODS: A total of 297 patients were recruited and their clinical characteristics and the changes of TCD variables were recorded. The independent prognostic factors for the ND after onset in the ICH patients were screened from multivariate Logistic regression analysis, which were served as inputs for the nomogram construction. Discrimination and calibration validations were performed to assess the performance of the nomogram [concordance index (C-index) for discrimination and Hosmer-Lemeshow (HL) test for calibration] and the decision curve analysis was applied to assess the clinical suitability. RESULTS: ΔaPI [defined as the change of pulsatility index (PI) between the 1st and 3rd day after onset for affected hemisphere] was independently associated with the ND after onset. Moreover, hematoma volume, presence of intraventricular hemorrhage, and Glasgow coma scale were also the independent prognostic factors of ND. The developed nomogram incorporating ΔaPI showed good discrimination (C-index: 0.916 after 1000 bootstrapping) and calibration (P=0.412, HL test) and yielded net benefits. CONCLUSION: The nomogram incorporating ΔaPI might be useful in predicting the risk of ND within 14 days after onset, which might help identify patients in the neurology department in need of further care.
Authors: Marcel J H Aries; Jan W Elting; Jacques De Keyser; Berry P H Kremer; Patrick C A J Vroomen Journal: Stroke Date: 2010-10-07 Impact factor: 7.914
Authors: Chitra Venkatasubramanian; Michael Mlynash; Anna Finley-Caulfield; Irina Eyngorn; Rajalakshmi Kalimuthu; R W Snider; Christine Anne Wijman Journal: Stroke Date: 2010-12-16 Impact factor: 7.914
Authors: Matthias Reinhard; Florian Neunhoeffer; Thomas A Gerds; Wolf-Dirk Niesen; Klaus-Juergen Buttler; Jens Timmer; Bernhard Schmidt; Marek Czosnyka; Cornelius Weiller; Andreas Hetzel Journal: Intensive Care Med Date: 2009-10-17 Impact factor: 17.440