title: Accuracy and clinical usefulness of intracerebral hemorrhage grading scores: a direct comparison in a UK population.
abstract: OBJECTIVE
  Various grading scores to predict survival after intracerebral hemorrhage (ICH) have been described. We aimed to test the accuracy and clinical usefulness of 3 well-known scores (original ICH score, modified ICH score, and ICH grading scale) in a large unselected cohort of typical ICH patients.
  
  
  METHODS
  A total of 1364 ICH cases were referred to our center from January 1, 2008, to October 17, 2010. Clinical details were prospectively recorded, and the first computed tomography brain scan was retrospectively reviewed to determine ICH volume and location and to identify intraventricular hemorrhage. The original ICH, ICH grading scale, and modified ICH score were calculated. Receiver operating characteristic and decision curves for 30-day mortality were generated.
  
  
  RESULTS
  A total of 1175 patients were included in the final analysis. All 3 scores and the Glasgow Coma Scale (GCS) divided cases into groups with highly significant differences in mortality. The area under the receiver operating characteristic curve was very similar for original ICH (0.861), ICH grading scale (0.874), and GCS (0.872), but was less for modified ICH score (0.824). Age was much less predictive (0.565). Combining GCS with age, log ICH volume, and intraventricular hemorrhage to derive a multifactorial risk of death at 30 days significantly increased the area under the receiver operating characteristic curve (0.897). All scores and GCS demonstrated a similar net benefit for threshold probabilities of 10% to 95%. Above 95%, the net benefit of GCS became inferior to the prognostic scores.
  
  
  CONCLUSIONS
  Although existing grading scores are highly predictive of 30-day mortality, GCS alone was as predictive in our cohort, but age was not.
authors.affiliation: Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal NHS Foundation Trust, United Kingdom. adrian.parry-jones@manchester.ac.uk
authors.forename: Adrian R
authors.initials: AR
authors.lastname: Parry-Jones
authors.forename: Kamran A
authors.initials: KA
authors.lastname: Abid
authors.forename: Mario
authors.initials: M
authors.lastname: Di Napoli
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Smith
authors.forename: Andy
authors.initials: A
authors.lastname: Vail
authors.forename: Hiren C
authors.initials: HC
authors.lastname: Patel
authors.forename: Andrew T
authors.initials: AT
authors.lastname: King
authors.forename: Pippa J
authors.initials: PJ
authors.lastname: Tyrrell
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012306:Risk; D012720:Severity of Illness Index; D013997:Time Factors; D006113:United Kingdom
keywords: Glasgow Coma Scale; decision curve analysis; intracerebral hemorrhage; prognosis; prognostic scores