title: Prognosticating Functional Outcome After Intracerebral Hemorrhage: The ICHOP Score.
abstract: BACKGROUND
  The morbidity, mortality, and monetary cost associated with intracerebral hemorrhage (ICH) is devastatingly high. Several scoring systems have been proposed to prognosticate outcomes after ICH, although the original ICH Score is still the most widely used. However, recent research suggests that systemic physiologic factors, such as those included in the Acute Physiology and Chronic Health Evaluation II score, may also influence outcome. In addition, no scoring systems to date have included premorbid functional status. Therefore, we propose a scoring system that incorporates these factors to prognosticate 3-month and 12-month functional outcomes.
  
  
  METHODS
  We used the Random Forest machine-learning technique to identify factors from a dataset of more than 200 data points per patient that were most strongly affiliated with functional outcome. We then used linear regression to create an initial model based on these factors and modified weightings to improve accuracy. Our scoring system was compared with the ICH Score for prognosticating functional outcomes.
  
  
  RESULTS
  Two separate scoring systems (Intracerebral Hemorrhage Outcomes Project 3 [ICHOP3] and ICHOP12) were developed for 3-month and 12-month functional outcomes using Glasgow Coma Scale, National Institutes of Health Stroke Scale, Acute Physiology and Chronic Health Evaluation II, premorbid modified Rankin Scale (mRS), and hematoma volume (3-month only). Patient outcomes were dichotomized into good (mRS score, 0-3) and poor (mRS score, 4-6) categories based on functional status. Areas under the curve in the derivation cohort for predicting mRS score were 0.89 (3-month) and 0.87 (12-month); both were significantly more discriminatory than the original ICH Score.
  
  
  CONCLUSIONS
  The ICHOP scores may provide more comprehensive evaluation of a patient's long-term functional prognosis by taking into account systemic physiologic factors as well as premorbid functional status.
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, USA. Electronic address: sean.vivek.gupta@gmail.com.
authors.forename: Vivek P
authors.initials: VP
authors.lastname: Gupta
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, USA.
authors.forename: Andrew L A
authors.initials: ALA
authors.lastname: Garton
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Sisti
authors.affiliation: Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York, USA.
authors.forename: Brandon R
authors.initials: BR
authors.lastname: Christophe
authors.affiliation: Division of Neurocritical Care NYU Langone Medical Center, Departments of Neurology and Neurosurgery, New York, USA.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Lord
authors.affiliation: Division of Neurocritical Care NYU Langone Medical Center, Departments of Neurology and Neurosurgery, New York, USA.
authors.forename: Ariane K
authors.initials: AK
authors.lastname: Lewis
authors.affiliation: Division of Critical Care Neurology, Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, USA.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Frey
authors.affiliation: Division of Critical Care Neurology, Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.affiliation: Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, New York, USA.
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069550:Machine Learning / Q000639:trends; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Functional outcome; ICH Score; Intracerebral hemorrhage; Prognostication; Stroke