Probability Assessment of Intracerebral Hemorrhage in Prehospital Emergency Patients

Overview

Journal Neurol Res Pract

Specialty Neurology

Date 2021 Jan 27

PMID 33499926

Citations 4

Authors

Frederik Geisler

Medschid Wesirow

Martin Ebinger

Alexander Kunz

Michal Rozanski

Carolin Waldschmidt

Joachim E Weber

Matthias Wendt

Benjamin Winter

Heinrich J Audebert

Affiliations

Soon will be listed here.

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.

Citing Articles

Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: a prospective cohort study.

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PMID: 39849021 PMC: 11757749. DOI: 10.1038/s41598-025-86116-6.

Development and internal validation of prehospital prediction models for identifying intracerebral haemorrhage in suspected stroke patients.

Almubayyidh M, Parry-Jones A, Jenkins D BMJ Neurol Open. 2024; 6(2):e000878.

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Physiological Variability during Prehospital Stroke Care: Which Monitoring and Interventions Are Used?.

Alshehri A, Ince J, Panerai R, Divall P, Robinson T, Minhas J Healthcare (Basel). 2024; 12(8).

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Prehospital identification of intracerebral haemorrhage: a scoping review of early clinical features and portable devices.

Almubayyidh M, Alghamdi I, Parry-Jones A, Jenkins D BMJ Open. 2024; 14(4):e079316.

PMID: 38643005 PMC: 11033659. DOI: 10.1136/bmjopen-2023-079316.

Clinical features and novel technologies for prehospital detection of intracerebral haemorrhage: a scoping review protocol.

Almubayyidh M, Alghamdi I, Parry-Jones A, Jenkins D BMJ Open. 2023; 13(5):e070228.

PMID: 37137559 PMC: 10163533. DOI: 10.1136/bmjopen-2022-070228.

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