title: Poor utility of grading scales in acute intracerebral hemorrhage: results from the INTERACT2 trial.
abstract: BACKGROUND
  Several simple clinical grading scores have been developed for intracerebral hemorrhage, primarily to predict 30-day mortality.
  
  
  OBJECTIVE
  We aimed to determine the accuracy of three popular scores (original intracerebral hemorrhage, modified intracerebral hemorrhage, and intracerebral hemorrhage grading scale) on 30-day mortality and 90-day death or major disability, and whether the magnitude of benefit varies according to prognosis graded by the three predictive scores.
  
  
  METHODS
  Data from the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial which included 2839 intracerebral hemorrhage patients (<6 hours) and elevated systolic blood pressure (150-220 mmHg), randomized to intensive (target systolic blood pressure <140 mmHg) or guideline-based (<180 mmHg) blood pressure management. Discrimination of scales for predicting death and poor outcome (modified Rankin scale 3-6) was evaluated in area under receiver operator characteristic curves.
  
  
  RESULTS
  Among 2556 (90%) participants with available data, the modified intracerebral hemorrhage had the highest discrimination (receiver operator characteristic 0·75) for 90-day poor outcome compared with the original intracerebral hemorrhage (receiver operator characteristic 0·68) and intracerebral hemorrhage grading scale (receiver operator characteristic 0·69). All scores had good positive predictive value (approximately 80-90%) for poor outcome but poor sensitivity and positive predictive value for death. The scores do not clearly discriminate a patient group most likely to benefit from blood pressure lowering.
  
  
  CONCLUSIONS
  Intracerebral hemorrhage prognostic scores are not useful in defining patients at high probability of early death, but they are reliable for predicting poor outcome, defined by death or major disability. Potential benefits of early intensive blood pressure lowering are broadly applicable across grades of severity defined by such scores.
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Heeley
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.|Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.|The George Institute for Global Health, University of Oxford, Oxford, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.|Seta University of Medical Science, Tsukinowa-cho, Otsu, Shiga, Japan.
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK.
authors.forename: Thompson
authors.initials: T
authors.lastname: Robinson
authors.affiliation: Department of Neurology, APHP - Hôpital Lariboisière and DHU NeuroVasc Paris - Sorbonne, Univ Paris Diderot - Sorbonne Paris Cité, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.affiliation: Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Parsons
authors.affiliation: Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Centro de Neurociencias, Universidad del Desarrollo, Santiago, Chile.|Departamento de Ciencias Neurológicas, Universidad de Chile, Santiago, Chile.
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Lavados
authors.affiliation: Department of Neurology, Peking University First Hospital, Beijing, China.
authors.forename: Yining
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Hejian City People's Hospital, Hebei, China.
authors.forename: Yanxia
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Stroke unit, Pitié-Salpêtriere Hospital, Paris, AP-HP, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Crozier
authors.affiliation: Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Parry-Jones
authors.affiliation: The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
mesh_terms: D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000401:mortality; D066264:Datasets as Topic; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: BP lowering treatment; ICH scales; INTERACT2; intracerebral hemorrhage; prognosis