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GRASPS Score of Menon et al for Predicting Symptomatic Intracranial Hemorrhage after Stroke Thrombolysis

Description

Menon et al reported the GRASPS score for predicting symptomatic intracranial hemorrhage for patients following intravenous thrombolytic therapy for ischemic stroke. The authors are from University of Calgary, University of California Los Angeles, Northwestern University, Michigan State University, Duke University and Massachusetts General Hospital..Data was from the Get With The Guidelines-Stroke (GWTG-Stroke) trial.


 

Patient selection: status post intravenous thrombolytic therapy for ischemic stroke

 

Outcome: symptomatic intracranial hemorrhage (neurological worsening within 36 hours of tPA infusion that is attributed to tPA and diagnosed by the treating physican based on imaging studies)

 

Parameters:

(1) G for glucose on admission in mg/dL

(2) R for race

(3) A for age in years

(4) S for sex

(5) P for systolic blood pressure in mm Hg

(6) S for stroke severity based on NIHSS score on admission

 

Parameters

Findings

Points

glucose on admission

< 100 mg/dL

2

 

100 to 149 mg/dL

6

 

>= 150 mg/dL

8

race

Asian

9

 

non-Asian

0

age in years

<= 60 years of age

8

 

61 to 70 years of age

11

 

71 to 80 years of age

15

 

> 80 years of age

17

sex

female

0

 

male

4

systolic blood pressure

< 120 mm Hg

10

 

120 to 149

14

 

150 to 179

18

 

>= 180 mm Hg

21

NIHSS stroke score

0 to 5

25

 

6 to 10

27

 

11 to 15

34

 

16 to 20

40

 

>= 21

42

 

total score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 45

• maximum score 101

• The higher the score the greater the risk for t-PA related ICH.

 

Score

Probability t-PA related ICH

< 50

< 1%

50 to 80

(0.0085 * ((points)^2)) - (0.851 * (points)) +22.14

80 to 101

(0.02725 * ((points)^2)) - 3.673 * (points)) + 127.8

 

Performance:

• The area under the ROC curve was 0.70. The Hosmer-Lemeshow test p value was 0.35.

 


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