Early Therapy Intensity Level (TIL) Predicts Mortality in Spontaneous Intracerebral Hemorrhage

Abstract

A simplified TIL score using evidenced-based patient-care parameters within first 3 days of admission after sICH was significantly associated with early mortality and good outcome. The next step is prospective validation of the simplified TIL score in a large clinical trial.

Prognostic models for intracerebral hemorrhage: systematic review and meta-analysis

“… 0·900 (0·027) Tuhrim´´ [ 29 ] 1988 Supratentorial hemorrhage Equation 30 days GCS score, hematoma size, and pulse pressure. 0·892 (0·042) Ziai [ 35 ] 2015 Primary ICH with IVH Score Discharge Temperature, glucose, intracranial pressure, and Do-Not-Resuscitate orders 0·850 (0·030) Zis [ 39 ] 2014 Non-operated primary ICH Score 30 days GCS, ICH size, INR, IVH spread, and infratentorial location. 0·920 (0·023) Functional outcome prediction tools Appelboom [ 10 ] 2012 AVM related ICH Score 3 months Age, IVH, infratentorial bleed, GCS, and hematoma size.…”

“…However, several studies included further specifications for patient inclusion namely age [ 12 ], cerebral amyloid related angiopathy [ 13 ], deep location [ 14 – 17 ], lobar location [ 18 ], supratentorial bleeds [ 16 , 19 – 33 ], presence of intraventricular hemorrhage [ 16 , 34 , 35 ], African ethnicity [ 36 ], non-comatose patients [ 22 , 37 ], comatose patients [ 38 ], medically treated patients [ 22 – 25 , 27 , 33 , 38 – 40 ], surgically treated patients [ 21 ], oral anticoagulant related bleeds [ 41 ], hypertensive patients [ 19 , 36 ], and dialysis patients [ 40 ]. The majority of studies ( n = 40) recruited patients from hospitals or emergency rooms [ 10 – 14 , 16 – 22 , 26 , 29 – 31 , 36 , 40 – 61 ] but nine studies recruited patients from intensive care units [ 24 , 28 , 32 , 33 , 35 , 38 , 62 – 64 ], three studies recruited patients from stroke units [ 34 , 37 , 65 ], six studies recruited patients from neurology/neurosurgery departments [ 15 , 25 , 27 , 39 , 66 , 67 ], and one study recruited patients from both an intensive care unit and a stroke unit [ 23 ]. Most prognostic tools were derived from cohort studies, with the exceptions being registries [ 29 , …”

“…Most prognostic tools were derived from cohort studies, with the exceptions being registries [ 29 , 30 , 43 , 51 , 64 ], randomized clinical trial data [ 14 , 42 ], case-control studies [ 26 ], and administrative databases [ 59 ]. Thirteen studies were multicentric [ 13 , 24 , 29 , 30 , 35 – 37 , 42 , 43 , 51 , 55 , 59 , 62 ], with two studies involving more than two countries [ 42 , 55 ]. The sampling method was not reported or unclear for 18 studies [ 12 , 15 , 17 , 21 , 23 , 24 , 26 , 29 , 30 , 32 , 36 , 42 , 54 , 61 , 63 , 66 – 68 ], being consecutive for all others.…”

“…Within the regression based tools, 51 were newly derived [ 13 – 17 , 19 , 20 , 22 – 41 , 44 – 51 , 53 – 60 , 63 – 65 , 67 ] and seven were model updates [ 10 , 42 , 43 , 46 , 52 , 62 ]. Newly derived models preferentially used automated methods (forward/backward stepwise) for predictor selection during multivariate modelling (reported in 30 derivation procedures [ 14 – 17 , 19 , 20 , 22 , 23 , 25 , 26 , 28 – 31 , 33 , 35 – 37 , 40 , 41 , 44 , 46 , 48 , 49 , 51 , 54 , 56 , 63 – 65 ]), whereas the method was unclear for ten [ 13 , 24 , 32 , 38 , 45 , 55 , 57 , 58 , 60 ]. Model updates consisted in intercept recalibrations [ 42 ], modifications of cut-off levels for specific variables [ 10 ], and removal or introduction of new variables [ 43 , 46 , 52 , 62 ].…”

“…Machine learning methods employed were artificial neural networks used in four tools [ 26 , 28 , 54 , 68 ], decision trees used in four tools [ 12 , 18 , 67 ], support vector machine used in one tool [ 54 ], random forests used in one tool [ 54 ], and a hybrid approach (decision tree + support vector machine) also used in one tool [ 61 ] (Table 1 ). Internal validation methods were used in 19 derivations: bootstrapping was used in two [ 58 , 59 ], cross-validation was used in ten [ 35 , 38 , 54 , 63 , 67 , 68 ] and split sample was used in seven [ 13 , 16 , 26 , 51 , 56 , 57 , 61 ].…”