UTILITY OF PREDICTIVE SCORES FOR POST TPA INTRACRANIAL HEMORRHAGE IN ACUTE ISCHEMIC STROKES TO OPTIMIZE 24-HOUR POST TPA SCAN UTILIZATION

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The risk of symptomatic ICH status post tPA is variable but ranges from 2-7%. The consensus from AHA/ASA guidelines in 2018 recommend a follow up CT scan 24 hours after IV tPA, which was a component of the original NINDS tPA study. However, there is increasing evidence that the scans themselves may be unnecessary. Several scoring scales have been developed to determine which patients are at highest risk after receiving tPA. Determining the most useful scoring scale to stratify the risk of ICH may help avoid a 24 hour follow up scan. METHODS: A retrospective review of 519 consecutive acute ischemic stroke patients who received tPA at multiple hospitals in central Texas from February 2014 to January 2019. The data was gathered through chart review utilizing a data collection form that contained pertinent baseline characteristics and relevant clinical findings. Established predictive scores, RICH, THRIVE, SEDAN, were included in the data sheet. Median and IQR (inter quartile range) is reported as data showed non normal distribution. P-value is derived from Mann Whitney U test, comparing the median score (THRIVE, SEDAN, RICH) between two groups. RESULTS: Our study included a population total of 492 patients. For patients with symptomatic intracranial hemorrhage (sICH), median scores were as follows: THRIVE 4.50 (p < 0.001), SEDAN 2.00 (p < 0.001) and RICH 3.00 (p = 0.1343). Additionally, the odds ratio for symptomatic intracranial hemorrhage were as follows: THRIVE 1.48 (p < 0.001), SEDAN 1.88 (p < 0.001) and RICH 1.27 (p = 0.1291). C-statistic for THRIVE was 0.72(,(95% CI, 0.63 – 0.80) and SEDAN score was 0.65 (95% CI, 0.61 – 0.79) compared to the RICH score for s ICH. CONCLUSIONS: The Thrive score performed the best for predicting sICH over the SEDAN and RICH scores. Further utility of these scores to exclude s ICH post tPA for stroke needs a prospective study. CLINICAL IMPLICATIONS: Ultimately, determining the patients at highest risk for intracranial hemorrhage conversion after tPA is crucial to better patient outcomes. Several scoring scales have been created in order to determine which patients are at highest risk. Determining the most useful scoring scale to stratify the risk of ICH may help avoid a 24 hour follow up scan. Avoiding a 24 hour follow up scan could reduce healthcare cost, reduce radiation exposure, and reduce utilization of healthcare resources. DISCLOSURES: no disclosure on file for Zunair Afghani; No relevant relationships by Nitin Agrawal, source=Web Response No relevant relationships by Shekhar Ghamande, source=Web Response No relevant relationships by Conner Moslander, source=Web Response No relevant relationships by Jennifer Rasmussen-Winkler, source=Web Response No relevant relationships by Alfredo Vazquez Sandoval, source=Web Response No relevant relationships by Heath White, source=Web Response