Prognostic Tools for Early Mortality in Hemorrhagic Stroke: Systematic Review and Meta-Analysis.
10.3988/jcn.2015.11.4.339
- Author:
Katharina MATTISHENT
1
;
Chun Shing KWOK
;
Liban ASHKIR
;
Kelum PELPOLA
;
Phyo Kyaw MYINT
;
Yoon Kong LOKE
Author Information
1. Health Evidence Synthesis Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK. y.loke@uea.ac.uk
- Publication Type:Meta-Analysis ; Original Article
- Keywords:
stroke;
prognostic scores;
risk prediction model;
mortality
- MeSH:
Area Under Curve;
Cerebral Hemorrhage;
Cohort Studies;
Discrimination (Psychology);
Mortality*;
Prospective Studies;
Retrospective Studies;
ROC Curve;
Stroke*
- From:Journal of Clinical Neurology
2015;11(4):339-348
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND PURPOSE: Several risk scores have been developed to predict mortality in intracerebral hemorrhage (ICH). We aimed to systematically determine the performance of published prognostic tools. METHODS: We searched MEDLINE and EMBASE for prognostic models (published between 2004 and April 2014) used in predicting early mortality (<6 months) after ICH. We evaluated the discrimination performance of the tools through a random-effects meta-analysis of the area under the receiver operating characteristic curve (AUC) or c-statistic. We evaluated the following components of the study validity: study design, collection of prognostic variables, treatment pathways, and missing data. RESULTS: We identified 11 articles (involving 41,555 patients) reporting on the accuracy of 12 different tools for predicting mortality in ICH. Most studies were either retrospective or post-hoc analyses of prospectively collected data; all but one produced validation data. The Hemphill-ICH score had the largest number of validation cohorts (9 studies involving 3,819 patients) within our systematic review and showed good performance in 4 countries, with a pooled AUC of 0.80 [95% confidence interval (CI)=0.77-0.85]. We identified several modified versions of the Hemphill-ICH score, with the ICH-Grading Scale (GS) score appearing to be the most promising variant, with a pooled AUC across four studies of 0.87 (95% CI=0.84-0.90). Subgroup testing found statistically significant differences between the AUCs obtained in studies involving Hemphill-ICH and ICH-GS scores (p=0.01). CONCLUSIONS: Our meta-analysis evaluated the performance of 12 ICH prognostic tools and found greater supporting evidence for 2 models (Hemphill-ICH and ICH-GS), with generally good performance overall.
