title: Neurochecks as a Biomarker of the Temporal Profile and Clinical Impact of Neurologic Changes after Intracerebral Hemorrhage.
abstract: BACKGROUND
  We sought to determine whether a quantitative neurocheck biomarker could characterize the temporal pattern of early neurologic changes after intracerebral hemorrhage (ICH), and the impact of those changes on long-term functional outcomes.
  
  
  METHODS
  We enrolled cases of spontaneous ICH in a prospective observational study. Patients underwent a baseline Glasgow Coma Scale (GCS) assessment, then hourly neurochecks using the GCS in a neuroscience intensive care unit. We identified a period of heightened neurologic instability by analyzing the average hourly rate of GCS change over 5 days from symptom onset. We used a multivariate regression model to test whether those early GCS score changes were independently associated with 3-month outcome measured by the modified Rankin Scale (mRS).
  
  
  RESULTS
  We studied 13,025 hours of monitoring from 132 cases. The average rate of neurologic change declined from 1.0 GCS points per hour initially to a stable baseline of .1 GCS points per hour beyond 12 hours from symptom onset (P < .05 for intervals before 12 hours). Change in GCS score within the initial 12 hours was an independent predictor of mRS at 3 months (odds ratio, .81 [95% confidence interval, .66-.99], P = .043) after adjustment for age, hematoma volume, hematoma location, initial GCS, and intraventricular hemorrhage.
  
  
  CONCLUSIONS
  Neurochecks are effective at detecting clinically important neurologic changes in the intensive care unit setting that are relevant to patients' long-term outcomes. The initial 12 hours is a period of frequent and prognostically important neurologic changes in patients with ICH.
authors.affiliation: Department of Neurology, Northwestern University, Chicago, Illinois. Electronic address: mbmaas@northwestern.edu.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Maas
authors.affiliation: Department of Neurology, Northwestern University, Chicago, Illinois.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Berman
authors.affiliation: Department of Neurology, Loma Linda University, Loma Linda, California.
authors.forename: James C
authors.initials: JC
authors.lastname: Guth
authors.affiliation: Department of Neurology, Northwestern University, Chicago, Illinois.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Liotta
authors.affiliation: Department of Neurology, Northwestern University, Chicago, Illinois.
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
authors.affiliation: Department of Neurology, Northwestern University, Chicago, Illinois.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Naidech
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology*; D009460:Neurologic Examination; D012044:Regression Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: Intracerebral hemorrhage; neurochecks; neurologic deterioration; neurologic worsening; neuromonitoring; outcomes