Ong et al reported the EDEMA (Enhanced Detection of Edema in Malignant Anterior Circulation Stroke) score. This can help to identify a patient at risk for malignant cerebral edema. The authors are from Massachusetts General Hospital, Brigham and Women's Hospital, and Washington University.
Exclusions: posterior circulation stroke, presentation after 24 hours, NIHSS < 8.
Parameters:
(1) basilar cistern effacement
(2) midline shift in mm
(3) blood glucose in mg/dL
(4) history of previous stroke
(5) intervention (thrombectomy or tPA)
Parameter
Finding
Points
basilar cistern effacement
no
0
yes
3
midline shift
0 mm
0
< 3 mm
1
3 to 5.9 mm
2
6 to 9 mm
4
> 9 mm
7
glucose
< 150 mg/dL
0
>= 150 mg/dL
2
history of previous stroke
no
1
yes
0
intervention
no
1
yes
0
score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 14
• A score >= 7 had a positive predictive value of 93% (specificity 99%, sensitivity 21%).
• A score >= 3 had the maximum Youden index (0.42).
Score
Malignant Edema
0
16%
1
25%
2
36%
3
49%
4
62%
5
73%
6
82%
7
88%
8
93%
9
96%
10
97%
11
98%
12
99%
Performance:
• The area under the ROC curve is 0.76.
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