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A risk score for in-hospital death in patients admitted with ischemic or hemorrhagic stroke.

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Date
2013-01-28
Authors
Smith, Eric E
Shobha, Nandavar
Dai, David
Olson, DaiWai M
Reeves, Mathew J
Saver, Jeffrey L
Hernandez, Adrian F
Peterson, Eric D
Fonarow, Gregg C
Schwamm, Lee H
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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 article
Subject
Aged
Aged, 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
Permalink
https://hdl.handle.net/10161/15019
Published Version (Please cite this version)
10.1161/JAHA.112.005207
Publication 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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Scholars@Duke

Hernandez

Adrian Felipe Hernandez

Duke Health Cardiology Professor
Peterson

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
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
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