Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score.
OBJECTIVE
Intracerebral hemorrhage (ICH) is the most fatal and disabling stroke subtype. Widely used tools for prediction of mortality are fundamentally limited in that they do not account for effects of withdrawal of care and are not designed to predict functional recovery. We developed an acute clinical score to predict likelihood of functional independence.


METHODS
We prospectively characterized 629 consecutive patients with ICH at hospital presentation. Predictors of functional independence (Glasgow Outcome Score > or = 4) at 90 days were used to develop a logistic regression-based risk stratification scale in a random subset of two thirds and validated in the remaining one third of the cohort.


RESULTS
At 90 days, 162 (26%) patients achieved independence. Age, Glasgow Coma Scale, ICH location, volume (all P<0.0001), and pre-ICH cognitive impairment (P=0.005) were independently associated with Glasgow Outcome Score > or = 4. The FUNC score was developed as a sum of individual points (0-11) based on strength of association with outcome. In both the development and validation cohorts, the proportion of patients who achieved Glasgow Outcome Score > or = 4 increased steadily with FUNC score. No patient assigned a FUNC score < or = 4 achieved functional independence, whereas > 80% with a score of 11 did. The predictive accuracy of the FUNC score remained unchanged when restricted to ICH survivors only, consistent with absence of confounding by early withdrawal of care.


CONCLUSIONS
FUNC score is a valid clinical assessment tool that identifies patients with ICH who will attain functional independence and thus, can provide guidance in clinical decision-making and patient selection for clinical trials.
Rost
Natalia S
NS
Massachusetts General Hospital, Center for Human Genetic Research, Boston, MA 02114, USA. nrost@partners.org
Smith
Eric E
EE
Chang
Yuchiao
Y
Snider
Ryan W
RW
Chanderraj
Rishi
R
Schwab
Kristin
K
FitzMaurice
Emily
E
Wendell
Lauren
L
Goldstein
Joshua N
JN
Greenberg
Steven M
SM
Rosand
Jonathan
J
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000503:physiopathology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology*