A risk score for in-hospital death in patients admitted with ischemic or hemorrhagic stroke.
Abstract
BACKGROUND: We aimed to derive and validate a single risk score for predicting death
from ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage
(SAH). METHODS AND RESULTS: Data from 333 865 stroke patients (IS, 82.4%; ICH, 11.2%;
SAH, 2.6%; uncertain type, 3.8%) in the Get With The Guidelines-Stroke database were
used. In-hospital mortality varied greatly according to stroke type (IS, 5.5%; ICH,
27.2%; SAH, 25.1%; unknown type, 6.0%; P<0.001). The patients were randomly divided
into derivation (60%) and validation (40%) samples. Logistic regression was used to
determine the independent predictors of mortality and to assign point scores for a
prediction model in the overall population and in the subset with the National Institutes
of Health Stroke Scale (NIHSS) recorded (37.1%). The c statistic, a measure of how
well the models discriminate the risk of death, was 0.78 in the overall validation
sample and 0.86 in the model including NIHSS. The model with NIHSS performed nearly
as well in each stroke type as in the overall model including all types (c statistics
for IS alone, 0.85; for ICH alone, 0.83; for SAH alone, 0.83; uncertain type alone,
0.86). The calibration of the model was excellent, as demonstrated by plots of observed
versus predicted mortality. CONCLUSIONS: A single prediction score for all stroke
types can be used to predict risk of in-hospital death following stroke admission.
Incorporation of NIHSS information substantially improves this predictive accuracy.
Type
Journal articleSubject
AgedAged, 80 and over
Brain Ischemia
Cerebral Hemorrhage
Chi-Square Distribution
Decision Support Techniques
Female
Hospital Mortality
Humans
Inpatients
Logistic Models
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Registries
Reproducibility of Results
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke
Subarachnoid Hemorrhage
United States
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https://hdl.handle.net/10161/15019Published Version (Please cite this version)
10.1161/JAHA.112.005207Publication Info
Smith, Eric E; Shobha, Nandavar; Dai, David; Olson, DaiWai M; Reeves, Mathew J; Saver,
Jeffrey L; ... Schwamm, Lee H (2013). A risk score for in-hospital death in patients admitted with ischemic or hemorrhagic
stroke. J Am Heart Assoc, 2(1). pp. e005207. 10.1161/JAHA.112.005207. Retrieved from https://hdl.handle.net/10161/15019.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Adrian Felipe Hernandez
Duke Health Cardiology Professor
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
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