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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

Subgroup analyses of the Hemphill-intracerebral hemorrhage model according to the study design and characteristics of participants. CI: confidence interval.
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Figure 3: Subgroup analyses of the Hemphill-intracerebral hemorrhage model according to the study design and characteristics of participants. CI: confidence interval.

Mentions: We conducted subgroup analyses looking at the prognostic value of the Hemphill-ICH model according to study design and patient characteristics (e.g., age and geographical location). We found that Hemphill-ICH scores generally performed well across different subgroups (Fig. 3), but there was a possible slight decrease in performance in those studies conducted outside of North America and Europe, or in those where the participants were on average younger than 70 years.


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)

Subgroup analyses of the Hemphill-intracerebral hemorrhage model according to the study design and characteristics of participants. CI: confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Subgroup analyses of the Hemphill-intracerebral hemorrhage model according to the study design and characteristics of participants. CI: confidence interval.
Mentions: We conducted subgroup analyses looking at the prognostic value of the Hemphill-ICH model according to study design and patient characteristics (e.g., age and geographical location). We found that Hemphill-ICH scores generally performed well across different subgroups (Fig. 3), but there was a possible slight decrease in performance in those studies conducted outside of North America and Europe, or in those where the participants were on average younger than 70 years.

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