title: Hemorrhagic Transformation (HT) and Symptomatic Intracerebral Hemorrhage (sICH) Risk Prediction Models for Postthrombolytic Hemorrhage in the Stroke Belt.
abstract: BACKGROUND
  Symptomatic intracerebral hemorrhage (sICH) remains the most feared complication of intravenous tissue plasminogen activator (IV tPA) treatment. We aimed to investigate how previously validated scoring methodologies would perform in treated patients in two US Stroke Belt states.
  
  
  RESULTS
  We retrospectively reviewed consecutive patients from two centers in two Stroke Belt states who received IV tPA (2008-2011). We assessed the ability of three models to predict sICH. sICH was defined as a type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale (NIHSS) score of ≥4 points or death. Among 457 IV tPA-treated patients, 19 (4.2%) had sICH (mean age 68, 26.3% Black, 63.2% female). The Cucchiara model was most predictive of sICH in the entire cohort (AUC: 0.6528) and most predictive of sICH among Blacks (OR = 6.03, 95% CI 1.07-34.1,P= 0.0422) when patients were dichotomized by score.
  
  
  CONCLUSIONS
  In our small sample from the racially heterogeneous US Stroke Belt, the Cucchiara model outperformed the other models at predicting sICH. While predictive models should not be used to justify nontreatment with thrombolytics, those interested in understanding contributors to sICH may choose to use the Cucchiara model until a Stroke Belt model is developed for this region.
authors: Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors: James E
authors: JE
authors: Siegler
authors: Stroke Program, Department of Neurology, School of Medicine, University of Alabama at Birmingham, RWUH 226M, 1720 2nd Avenue S, Birmingham, AL 35249, USA.
authors: Muhammad
authors: M
authors: Alvi
authors: Stroke Program, Department of Neurology, School of Medicine, University of Alabama at Birmingham, RWUH 226M, 1720 2nd Avenue S, Birmingham, AL 35249, USA ; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL 35249, USA.
authors: Amelia K
authors: AK
authors: Boehme
authors: Stroke Program, Department of Neurology, School of Medicine, University of Alabama at Birmingham, RWUH 226M, 1720 2nd Avenue S, Birmingham, AL 35249, USA.
authors: Michael J
authors: MJ
authors: Lyerly
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL 35249, USA ; Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), Birmingham, AL 35249, USA ; Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED), Minority Health & Health Disparities Research Center (MHRC), Birmingham, AL 35249, USA.
authors: Karen C
authors: KC
authors: Albright
authors: Stroke Program, Department of Neurology, School of Medicine, University of Alabama at Birmingham, RWUH 226M, 1720 2nd Avenue S, Birmingham, AL 35249, USA.
authors: Reza Bavarsad
authors: RB
authors: Shahripour
authors: Stroke Program, Department of Neurology, School of Medicine, University of Alabama at Birmingham, RWUH 226M, 1720 2nd Avenue S, Birmingham, AL 35249, USA.
authors: Pawan V
authors: PV
authors: Rawal
authors: Stroke Program, Department of Neurology, School of Medicine, University of Alabama at Birmingham, RWUH 226M, 1720 2nd Avenue S, Birmingham, AL 35249, USA.
authors: Niren
authors: N
authors: Kapoor
authors: Stroke Program, Department of Neurology, School of Medicine, University of Alabama at Birmingham, RWUH 226M, 1720 2nd Avenue S, Birmingham, AL 35249, USA.
authors: April
authors: A
authors: Sisson
authors: Stroke Program, Department of Neurology, School of Medicine, University of Alabama at Birmingham, RWUH 226M, 1720 2nd Avenue S, Birmingham, AL 35249, USA.
authors: J Thomas
authors: JT
authors: Houston
authors: Stroke Program, Department of Neurology, School of Medicine, University of Alabama at Birmingham, RWUH 226M, 1720 2nd Avenue S, Birmingham, AL 35249, USA ; School of Nursing, University of Alabama at Birmingham, AL 35249, USA.
authors: Anne W
authors: AW
authors: Alexandrov
authors: Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
authors: Sheryl
authors: S
authors: Martin-Schild
authors: Stroke Program, Department of Neurology, School of Medicine, University of Alabama at Birmingham, RWUH 226M, 1720 2nd Avenue S, Birmingham, AL 35249, USA.
authors: Andrei V
authors: AV
authors: Alexandrov