Limits...
Prognostic Tools for Early Mortality in Hemorrhagic Stroke: Systematic Review and Meta-Analysis.

Mattishent K, Kwok CS, Ashkir L, Pelpola K, Myint PK, Loke YK - J Clin Neurol (2015)

Bottom Line: We evaluated the discrimination performance of the tools through a random-effects meta-analysis of the area under the receiver operating characteristic curve (AUC) or c-statistic.Subgroup testing found statistically significant differences between the AUCs obtained in studies involving Hemphill-ICH and ICH-GS scores (p=0.01).Our meta-analysis evaluated the performance of 12 ICH prognostic tools and found greater supporting evidence for 2 models (Hemphill-ICH and ICH-GS), with generally good performance overall.

View Article: PubMed Central - PubMed

Affiliation: Health Evidence Synthesis Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.

ABSTRACT

Background and purpose: Several risk scores have been developed to predict mortality in intracerebral hemorrhage (ICH). We aimed to systematically determine the performance of published prognostic tools.

Methods: We searched MEDLINE and EMBASE for prognostic models (published between 2004 and April 2014) used in predicting early mortality (<6 months) after ICH. We evaluated the discrimination performance of the tools through a random-effects meta-analysis of the area under the receiver operating characteristic curve (AUC) or c-statistic. We evaluated the following components of the study validity: study design, collection of prognostic variables, treatment pathways, and missing data.

Results: We identified 11 articles (involving 41,555 patients) reporting on the accuracy of 12 different tools for predicting mortality in ICH. Most studies were either retrospective or post-hoc analyses of prospectively collected data; all but one produced validation data. The Hemphill-ICH score had the largest number of validation cohorts (9 studies involving 3,819 patients) within our systematic review and showed good performance in 4 countries, with a pooled AUC of 0.80 [95% confidence interval (CI)=0.77-0.85]. We identified several modified versions of the Hemphill-ICH score, with the ICH-Grading Scale (GS) score appearing to be the most promising variant, with a pooled AUC across four studies of 0.87 (95% CI=0.84-0.90). Subgroup testing found statistically significant differences between the AUCs obtained in studies involving Hemphill-ICH and ICH-GS scores (p=0.01).

Conclusions: Our meta-analysis evaluated the performance of 12 ICH prognostic tools and found greater supporting evidence for 2 models (Hemphill-ICH and ICH-GS), with generally good performance overall.

No MeSH data available.


Related in: MedlinePlus

Meta-analysis of the areas under the receiver operating characteristic curve (AUC) for various prognostic models. CI: confidence interval, ICH: intracerebral hemorrhage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4596099&req=5

Figure 2: Meta-analysis of the areas under the receiver operating characteristic curve (AUC) for various prognostic models. CI: confidence interval, ICH: intracerebral hemorrhage.

Mentions: The AUCs from individual studies and the pooled mean AUCs across studies are shown in Fig. 2.


Prognostic Tools for Early Mortality in Hemorrhagic Stroke: Systematic Review and Meta-Analysis.

Mattishent K, Kwok CS, Ashkir L, Pelpola K, Myint PK, Loke YK - J Clin Neurol (2015)

Meta-analysis of the areas under the receiver operating characteristic curve (AUC) for various prognostic models. CI: confidence interval, ICH: intracerebral hemorrhage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596099&req=5

Figure 2: Meta-analysis of the areas under the receiver operating characteristic curve (AUC) for various prognostic models. CI: confidence interval, ICH: intracerebral hemorrhage.
Mentions: The AUCs from individual studies and the pooled mean AUCs across studies are shown in Fig. 2.

Bottom Line: We evaluated the discrimination performance of the tools through a random-effects meta-analysis of the area under the receiver operating characteristic curve (AUC) or c-statistic.Subgroup testing found statistically significant differences between the AUCs obtained in studies involving Hemphill-ICH and ICH-GS scores (p=0.01).Our meta-analysis evaluated the performance of 12 ICH prognostic tools and found greater supporting evidence for 2 models (Hemphill-ICH and ICH-GS), with generally good performance overall.

View Article: PubMed Central - PubMed

Affiliation: Health Evidence Synthesis Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.

ABSTRACT

Background and purpose: Several risk scores have been developed to predict mortality in intracerebral hemorrhage (ICH). We aimed to systematically determine the performance of published prognostic tools.

Methods: We searched MEDLINE and EMBASE for prognostic models (published between 2004 and April 2014) used in predicting early mortality (<6 months) after ICH. We evaluated the discrimination performance of the tools through a random-effects meta-analysis of the area under the receiver operating characteristic curve (AUC) or c-statistic. We evaluated the following components of the study validity: study design, collection of prognostic variables, treatment pathways, and missing data.

Results: We identified 11 articles (involving 41,555 patients) reporting on the accuracy of 12 different tools for predicting mortality in ICH. Most studies were either retrospective or post-hoc analyses of prospectively collected data; all but one produced validation data. The Hemphill-ICH score had the largest number of validation cohorts (9 studies involving 3,819 patients) within our systematic review and showed good performance in 4 countries, with a pooled AUC of 0.80 [95% confidence interval (CI)=0.77-0.85]. We identified several modified versions of the Hemphill-ICH score, with the ICH-Grading Scale (GS) score appearing to be the most promising variant, with a pooled AUC across four studies of 0.87 (95% CI=0.84-0.90). Subgroup testing found statistically significant differences between the AUCs obtained in studies involving Hemphill-ICH and ICH-GS scores (p=0.01).

Conclusions: Our meta-analysis evaluated the performance of 12 ICH prognostic tools and found greater supporting evidence for 2 models (Hemphill-ICH and ICH-GS), with generally good performance overall.

No MeSH data available.


Related in: MedlinePlus