TURN Score Predicts 24-Hour Cerebral Edema After IV Thrombolysis.
Cerebral edema is associated with poor outcome after IV thrombolysis. We recently described the TURN score (Thrombolysis risk Using mRS and NIHSS), a predictor of severe outcome after IV thrombolysis. Our purpose was to evaluate its ability to predict 24-h cerebral edema.



We retrospectively analyzed data from 303 patients who received IV rt-PA during the NINDS rt-PA trial. Measures of brain swelling included edema, mass effect and midline shift assessed at baseline, at 24 h and new onset at 24 h. Outcome was assessed using intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH), 90-day severe outcome, and 90-day mortality. Statistical associations were assessed by logistic regression reporting odds ratios (OR) and by areas under the receiver operating characteristic curves (AUROC).



Baseline brain swelling did not predict poor outcome; however, 24-h brain swelling predicted ICH (OR 5.69, P < 0.001), sICH (OR 9.50, P = 0.01), 90-day severe outcome (OR 7.10, P < 0.001), and 90-day mortality (OR 5.65, P = 0.01). Similar results were seen for new brain swelling at 24 h. TURN predicted 24-hour brain swelling (OR 2.5, P < 0.001; AUROC 0.69, 95 % CI 0.63-0.75) and new brain swelling at 24 h (OR 2.1, P < 0.001; AUROC 0.67, 95 % CI 0.61-0.73).



Cerebral edema at 24 h is associated with poor outcome and 90-day mortality. TURN predicts ischemic stroke patients who will develop 24-h cerebral edema after IV thrombolysis.
Yale School of Medicine, New Haven, CT, USA.
David
D
Asuzu
Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, LCI 10, 15 York Street, New Haven, CT, USA.
Karin
K
Nyström
Yale School of Medicine, New Haven, CT, USA.
Anirudh
A
Sreekrishnan
Yale School of Medicine, New Haven, CT, USA.|Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, LCI 10, 15 York Street, New Haven, CT, USA.
Joseph
J
Schindler
Yale School of Medicine, New Haven, CT, USA.|Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, LCI 10, 15 York Street, New Haven, CT, USA.
Charles
C
Wira
Yale School of Medicine, New Haven, CT, USA.|Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, LCI 10, 15 York Street, New Haven, CT, USA.
David
D
Greer
Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, LCI 10, 15 York Street, New Haven, CT, USA.
Janet
J
Halliday
Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
W Taylor
WT
Kimberly
Yale School of Medicine, New Haven, CT, USA. kevin.sheth@yale.edu.|Yale Department of Emergency Medicine, Division of Vascular Neurology, Division of Neurocritical Care and Emergency Neurology, Yale Department of Neurology, Yale-New Haven Hospital, LCI 10, 15 York Street, New Haven, CT, USA. kevin.sheth@yale.edu.
Kevin N
0000-0002-5681-4965
KN
Sheth
D001929:Brain Edema / Q000175:diagnosis* / Q000401:mortality; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000401:mortality; D004311:Double-Blind Method; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
IV thrombolysis; Intracerebral hemorrhage; Predictive scores; Severe outcomes