Cappellari et al reported a nomogram for predicting symptomatic intracerebral hemorrhage after intravenous thrombolysis for stroke. The authors are from Azienda Ospedaliera Universitaria Integrata, Fracastoro Hospital San Bonifacio and Universita degli Studi di Roma "La Sapienza" in Italy.
Patient selection: intravenous thrombolysis for stroke
Outcome: symptomatic intracerebral hemorrhage (sICH)
Parameters:
(1) systolic blood pressure in mm Hg from 60 to 185
(2) hyperdense artery sign
(3) current infarction sign
(4) blood glucose in mg/dL from 50 to 400
(5) onset-to-treatment time for thrombolysis in minutes from 10 to 270
(6) age from 18 to 101
(7) NIHSS score from 0 to 42
(8) oral anticoagulant with INR <= 1.7
(9) therapy (aspirin plus clopidogrel, aspirin alone)
points for systolic blood pressure =
= (0.03789 * (SBP)) + 0.012517
points for glucose =
= (0.02495 * (glucose)) + 0.012815
points of onset-to-treatment time =
= (0.010449 * (OTT)) + 0.011837
points for age =
= (0.080245 * (age)) + 0.023766
points for NIHSS =
= (0.21217 * (NIHSS)) + 0.071566
|
Parameter
|
Finding
|
Points
|
|
hyperdense artery sign
|
no
|
0
|
|
|
yes
|
1.4
|
|
current infarction sign
|
no
|
0
|
|
|
yes
|
1.6
|
|
oral anticoagulant with INR <= 1.7
|
no
|
0
|
|
|
yes
|
3.1
|
|
therapy
|
aspirin plus clopidogrel
|
3.5
|
|
|
aspirin alone
|
1.9
|
|
|
other
|
0
|
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 46.5
• The higher the score the greater the risk of intracerebral hemorrhage.
X =
= (0.23036 * (score)) - 7.9693
probability of sICH =
= 1 / (1 + EXP((-1) * X))
