Journal of Emergencies, Trauma, and Shock
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 Table of Contents    
LETTER TO EDITOR  
Year : 2015  |  Volume : 8  |  Issue : 3  |  Page : 171-172
Application of a scoring instrument to predict intracerebral hemorrhage and outcome after thrombolysis for acute ischemic stroke


1 Department of Pharmacy, Advocate Christ Medical Center, Advocate Children's Hospital, Chicago, USA
2 Section of Emergency Medicine, University of Chicago Medicine, Chicago, USA
3 Department of Pulmonary and Critical Care, University Medicine, Rhode Island Hospital, Chicago, USA
4 Department of Emergency Medicine, Advocate Christ Medical Center, Chicago, USA
5 Department of Neurology, Advocate Christ Medical Center, Chicago, USA

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Date of Web Publication13-Jul-2015
 

How to cite this article:
Sweis RT, Kerem Y, Waghchoure S, Kulstad EB, Wichter MD. Application of a scoring instrument to predict intracerebral hemorrhage and outcome after thrombolysis for acute ischemic stroke. J Emerg Trauma Shock 2015;8:171-2

How to cite this URL:
Sweis RT, Kerem Y, Waghchoure S, Kulstad EB, Wichter MD. Application of a scoring instrument to predict intracerebral hemorrhage and outcome after thrombolysis for acute ischemic stroke. J Emerg Trauma Shock [serial online] 2015 [cited 2019 Jun 26];8:171-2. Available from: http://www.onlinejets.org/text.asp?2015/8/3/171/160743


Dear Editor,

Despite risk of symptomatic intracerebral hemorrhage (ICH), thrombolytic therapy may improve patient outcomes in acute ischemic stroke. [1],[4] We sought to determine if the hemorrhage after thrombolysis (HAT) score, a five-point scale used to predict risk of HAT, might be a useful decision-making tool in the community hospital setting [Table 1]. We reviewed all 39 patients who presented to our emergency department between March 2006 and October 2008 and received thrombolytics for acute stroke. Outcomes were determined by review of medical records and telephone contact with patients or family members. Outcome measures were ICH, mortality and mRS <2. The median age of patients was 72 (IQR 56-80), and median National Institutes of Health Stroke Scale (NIHSS) was 11 (IQR 6-17), of which 64% were female. Twelve patients (31%, 95%CI: 16-46%) developed ICH (mean NIHSS = 15). Six patients (15%, 95%CI: 4-27%) died (mean NIHSS = 19). The area under the receiver operating characteristic curve (AUC) measuring the ability of the HAT score to predict ICH was 0.66 (95%CI: 0.47-0.84). The AUC to predict mortality was 0.67 (95%CI: 0.43-0.91) and to predict favorable outcome after stroke (mRS <2) was 0.77 (95%CI: 0.62-0.91) [Figure 1]. Despite data being retrospectively gathered from a single hospital emergency department, valuable information was nonetheless observed. The HAT score performed marginally well in predicting a favorable outcome after acute ischemic stroke, perhaps providing an additional risk stratification tool when considering thrombolytic therapy. [2],[3],[5]
Table 1: Hemorrhage after thrombolysis score scale

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Figure 1: Area under receiver operating characteristic curve for favorable outcome (mRS <2)

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   References Top

1.
Brown DL, Barsan WG, Lisabeth LD, Gallery ME, Morgenstern LB. Survey of emergency physicians about recombinant tissue plasminogen activator for acute ischemic stroke. Ann Emerg Med 2005;46:56-60.  Back to cited text no. 1
    
2.
Kent DM, Selker HP, Ruthazer R, Bluhmki E, Hacke W. The stroke-thrombolytic predictive instrument: A predictive instrument for intravenous thrombolysis in acute ischemic stroke. Stroke 2006;37:2957-62.  Back to cited text no. 2
    
3.
Lou M, Safdar A, Mehdiratta M, Kumar S, Schlaug G, Caplan L, et al. The HAT Score: A simple grading scale for predicting hemorrhage after thrombolysis. Neurology 2008;71:1417-23.  Back to cited text no. 3
    
4.
Meurer WJ, Majersik JJ, Frederiksen SM, Kade AM, Sandretto AM, Scott PA. Provider perceptions of barriers to the emergency use of tPA for acute ischemic stroke: A qualitative study. BMC Emerg Med 2011;11:5.  Back to cited text no. 4
    
5.
Strbian D, Meretoja A, Ahlhelm FJ, Pitkäniemi J, Lyrer P, Kaste M, et al. Predicting outcome of IV thrombolysis-treated ischemic stroke patients: The DRAGON score. Neurology 2012;78:427-32.  Back to cited text no. 5
    

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Correspondence Address:
Yaniv Kerem
Section of Emergency Medicine, University of Chicago Medicine, Chicago
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.160743

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