title: The DASH score: a simple score to assess risk for development of malignant middle cerebral artery infarction.
abstract: OBJECTIVE
  The aim of the present study was to devise a simple grading scale for assessing the risk of development of malignant MCA infarction (MMI).
  
  
  METHODS
  Using MRI, patients with MCA infarction and proximal vessel occlusion (ICA or M1) within 24h of onset were retrospectively studied. MMI was defined as clinical deterioration, midline shift ≥ 5 mm, or brain herniation within 48 h of admission. We evaluated clinical factors independently associated with MMI and created a simple score according to the multivariate logistic regression analysis.
  
  
  RESULTS
  Subjects comprised 119 patients, 57 of which (47.9%) developed MMI. Multivariate logistic regression analysis revealed the following independent factors associated with MMI: DWI ASPECTS ≤ 3 [odds ratio (OR), 4.16; 95% CI, 1.36-12.66, P=0.012], ACA territory involvement [OR, 6.90; 95% confidence interval [CI], 2.06-23.10, P=0.002], M1 susceptibility vessel sign (SVS) on T2*-gradient echo [OR, 4.55; 95% CI, 1.38-14.98, P=0.013], and hyperglycemia (glucose value ≥ 145 mg/dl) [OR, 5.31; 95% CI, 1.80-15.68, P=0.002]. These four variables were selected for use in the DASH score, with DWI ASPECTS ≤ 3 as 1 point, ACA territory involvement as 1 point, M1 SVS as 1 point, and hyperglycemia as 1 point. The likelihood of developing MMI for each score was as follows: score 0, 9.1%; score 1, 20.5%; score 2, 63.0%; score 3-4, 96.8%. The C statistic for the score was 0.88 (95% CI, 0.82-0.94, P<0.001).
  
  
  CONCLUSIONS
  Our DASH score reliably assessed a risk for development of MMI in large MCA infarctions.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki City, Okayama 701-0192, Japan. Electronic address: t.shimo0702@gmail.com.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimoyama
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki City, Okayama 701-0192, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki City, Okayama 701-0192, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Uemura
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki City, Okayama 701-0192, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki City, Okayama 701-0192, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Saji
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki City, Okayama 701-0192, Japan.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki City, Okayama 701-0192, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Iguchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
keywords: DWI ASPECTS; Hyperglycemia; Magnetic resonance imaging; Malignant middle cerebral artery infarction; Risk score; Susceptibility vessel sign