Predicting mortality in spontaneous intracerebral Hemorrhage -: Can modification to original score improve the prediction?

Background and Purpose - A clinical grading scale for intracerebral hemorrhage (ICH), formally ICH score, was recently developed showing to predict 30-day mortality in a simple and reliable manner. The aim of the present study was to validate the original ICH ( oICH) score in an independent cohort of patients from a developing country assessing 30-day mortality and 6-month functional outcome and whether its modifications can improve prediction. Methods - Consecutive patients admitted with acute ICH between January 1, 2003, and July 31, 2004, were prospectively included. oICH score was applied and 2 modified ICH ( mICH) scores were created with the same variables, except localization, of the oICH score but with different cutoff values. Outcome was assessed as 30-day mortality and 6-month good outcome ( Glasgow Outcome Scale [GOS] 4 to 5). Results - A total of 153 patients were included during study period. Thirty-day mortality rate was 34.6% ( n = 53), and 59 patients (38.6%) had good functional outcome ( GOS 4 to 5) at 6 months. The oICH and mICH scores predicted mortality equally well. According to Youden's index (J), the oICH score was a reliable predictor for mortality ( J = 0.59) but less reliable for predicting good outcome ( J = 0.54). The mICH scores were equal in predicting mortality but better for predicting good outcome than the oICH score ( J = 0.60). Conclusions - oICH score also confirms its validity in a socially and culturally different population. Modifications of oICH do not improve its 30-day mortality prediction but improve its ability to predict good functional outcome at 6 months.