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Symptomatic intracranial hemorrhage after stroke thrombolysis: The SEDAN Score
Author(s) -
Strbian Daniel,
Engelter Stefan,
Michel Patrik,
Meretoja Atte,
Sekoranja Lucka,
Ahlhelm Frank J.,
Mustanoja Satu,
Kuzmanovic Igor,
Sairanen Tiina,
Forss Nina,
Cordier Maria,
Lyrer Philippe,
Kaste Markku,
Tatlisumak Turgut
Publication year - 2012
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.23546
Subject(s) - medicine , thrombolysis , receiver operating characteristic , cohort , logistic regression , stroke (engine) , area under the curve , intracerebral hemorrhage , framingham risk score , subarachnoid hemorrhage , myocardial infarction , mechanical engineering , disease , engineering
Objective: A study was undertaken to develop a score for assessing risk for symptomatic intracranial hemorrhage (sICH) in ischemic stroke patients treated with intravenous (IV) thrombolysis. Methods: The derivation cohort comprised 974 ischemic stroke patients treated (1995–2008) with IV thrombolysis at the Helsinki University Central Hospital. The predictive value of parameters associated with sICH (European Cooperative Acute Stroke Study II) was evaluated, and we developed our score according to the magnitude of logistic regression coefficients. We calculated absolute risks and likelihood ratios of sICH per increasing score points. The score was validated in 828 patients from 3 Swiss cohorts (Lausanne, Basel, and Geneva). Performance of the score was tested with area under a receiver operating characteristic curve (AUC‐ROC). Results: Our SEDAN score (0 to 6 points) comprises baseline blood S ugar (glucose; 8.1–12.0mmol/l [145–216mg/dl] = 1; >12.0mmol/l [>216 mg/dl] = 2), E arly infarct signs (yes = 1) and (hyper) D ense cerebral artery sign (yes = 1) on admission computed tomography scan, A ge (>75 years = 1), and NIH Stroke Scale on admission (≥10 = 1). Absolute risk for sICH in the derivation cohort was: 1.4%, 2.9%, 8.5%, 12.2%, 21.7%, and 33.3% for 0, 1, 2, 3, 4, and 5 score points, respectively. In the validation cohort, absolute risks were similar (1.0%, 3.5%, 5.1%, 9.2%, 16.9%, and 27.8%, respectively). AUC‐ROC was 0.77 (0.71–0.83; p < 0.001). Interpretation: Our SEDAN score reliably assessed risk for sICH in IV thrombolysis‐treated patients with anterior‐ and posterior circulation ischemic stroke, and it can support clinical decision making in high‐risk patients. External validation of the score supports its generalization. ANN NEUROL 2012;