Faigle et al reported the INTRINSIC score to identify a patient with intracerebral hemorrhage (ICH) who will not need critical care. This can help to reduce unnecessary care. The authors are from Johns Hopkins University, University of Miami and Case Western Reserve University.
INTRINSIC stands for Intensive Care Triaging in Spontaneous Intracerebral Hemorrhage.
Patient selection: spontaneous intracerebral hemorrhage
Parameters:
(1) systolic blood pressure
(2) Glasgow coma scale (GCS)
(3) intracerebral hemorrhage volume in mL on imaging study
(4) intraventricular hemorrhage (IVH)
Parameter
|
Finding
|
Points
|
systolic blood pressure
|
< 160 mm Hg
|
0
|
|
160 to 190 mm Hg
|
1
|
|
> 190 mm Hg
|
3
|
Glasgow coma scale
|
14 or 15
|
0
|
|
8 to 13
|
1
|
|
< 8
|
3
|
ICH volume
|
< 16 mL
|
0
|
|
16 to 40 mL
|
1
|
|
> 40 mL
|
2
|
intraventricular hemorrhage
|
none
|
0
|
|
present
|
1
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• The higher the score the greater the need for critical care.
• A patient who did not need critical care in the Emergency Department may need it later.
• If a patient has a score of 0 and no need for critical care in the ED, then critical care was only needed at some point in 6% of patient.
• A score < 2 predicted no need for critical care with a sensitivity of 49% and specificity of 89%.
• A score <3 predicted no need for critical care with a sensitivity of 62% and specificity of 83%.
Performance:
• The area under the ROC curve is 0.82.