title: Symptomatic intracranial hemorrhage after stroke thrombolysis: the SEDAN score.
abstract: OBJECTIVE
  A study was undertaken to develop a score for assessing risk for symptomatic intracranial hemorrhage (sICH) in ischemic stroke patients treated with intravenous (IV) thrombolysis.
  
  
  METHODS
  The derivation cohort comprised 974 ischemic stroke patients treated (1995-2008) with IV thrombolysis at the Helsinki University Central Hospital. The predictive value of parameters associated with sICH (European Cooperative Acute Stroke Study II) was evaluated, and we developed our score according to the magnitude of logistic regression coefficients. We calculated absolute risks and likelihood ratios of sICH per increasing score points. The score was validated in 828 patients from 3 Swiss cohorts (Lausanne, Basel, and Geneva). Performance of the score was tested with area under a receiver operating characteristic curve (AUC-ROC).
  
  
  RESULTS
  Our SEDAN score (0 to 6 points) comprises baseline blood Sugar (glucose; 8.1-12.0 mmol/l [145-216 mg/dl] = 1; >12.0 mmol/l [>216 mg/dl] = 2), Early infarct signs (yes = 1) and (hyper)Dense cerebral artery sign (yes = 1) on admission computed tomography scan, Age (>75 years = 1), and NIH Stroke Scale on admission (≥10 = 1). Absolute risk for sICH in the derivation cohort was: 1.4%, 2.9%, 8.5%, 12.2%, 21.7%, and 33.3% for 0, 1, 2, 3, 4, and 5 score points, respectively. In the validation cohort, absolute risks were similar (1.0%, 3.5%, 5.1%, 9.2%, 16.9%, and 27.8%, respectively). AUC-ROC was 0.77 (0.71-0.83; p < 0.001).
  
  
  CONCLUSIONS
  Our SEDAN score reliably assessed risk for sICH in IV thrombolysis-treated patients with anterior- and posterior circulation ischemic stroke, and it can support clinical decision making in high-risk patients. External validation of the score supports its generalization.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Finland. daniel.strbian@hus.fi
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.forename: Stefan
authors.initials: S
authors.lastname: Engelter
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.forename: Atte
authors.initials: A
authors.lastname: Meretoja
authors.forename: Lucka
authors.initials: L
authors.lastname: Sekoranja
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Ahlhelm
authors.forename: Satu
authors.initials: S
authors.lastname: Mustanoja
authors.forename: Igor
authors.initials: I
authors.lastname: Kuzmanovic
authors.forename: Tiina
authors.initials: T
authors.lastname: Sairanen
authors.forename: Nina
authors.initials: N
authors.lastname: Forss
authors.forename: Maria
authors.initials: M
authors.lastname: Cordier
authors.forename: Philippe
authors.initials: P
authors.lastname: Lyrer
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015331:Cohort Studies; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects*