Simple Clinical Scale Research Articles

Machine learning in the prediction of post-stroke cognitive impairment: a systematic review and meta-analysis.

Cognitive impairment is a detrimental complication of stroke that compromises the quality of life of the patients and poses a huge burden on society. Due to the lack of effective early prediction tools in clinical practice, many researchers have introduced machine learning (ML) into the prediction of post-stroke cognitive impairment (PSCI). However, the mathematical models for ML are diverse, and their accuracy remains highly contentious. Therefore, this study aimed to examine the efficiency of ML in the prediction of PSCI. Relevant articles were retrieved from Cochrane, Embase, PubMed, and Web of Science from the inception of each database to 5 December 2022. Study quality was evaluated by PROBAST, and c-index, sensitivity, specificity, and overall accuracy of the prediction models were meta-analyzed. A total of 21 articles involving 7,822 stroke patients (2,876 with PSCI) were included. The main modeling variables comprised age, gender, education level, stroke history, stroke severity, lesion volume, lesion site, stroke subtype, white matter hyperintensity (WMH), and vascular risk factors. The prediction models used were prediction nomograms constructed based on logistic regression. The pooled c-index, sensitivity, and specificity were 0.82 (95% CI 0.77-0.87), 0.77 (95% CI 0.72-0.80), and 0.80 (95% CI 0.71-0.86) in the training set, and 0.82 (95% CI 0.77-0.87), 0.82 (95% CI 0.70-0.90), and 0.80 (95% CI 0.68-0.82) in the validation set, respectively. ML is a potential tool for predicting PSCI and may be used to develop simple clinical scoring scales for subsequent clinical use. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=383476.

EXplainable AI Allows Predicting Upper Limb Rehabilitation Outcomes in Sub-Acute Stroke Patients.

While stroke is one of the leading causes of disability, the prediction of upper limb (UL) functional recovery following rehabilitation is still unsatisfactory, hampered by the clinical complexity of post-stroke impairment. Predictive models leading to accurate estimates while revealing which features contribute most to the predictions are the key to unveil the mechanisms subserving the post-intervention recovery, prompting a new focus on individualized treatments and precision medicine in stroke. Machine learning (ML) and explainable artificial intelligence (XAI) are emerging as the enabling technology in different fields, being promising tools also in clinics. In this study, we had the twofold goal of evaluating whether ML can allow deriving accurate predictions of UL recovery in sub-acute patients, and disentangling the contribution of the variables shaping the outcomes. To do so, Random Forest equipped with four XAI methods was applied to interpret the results and assess the feature relevance and their consensus. Our results revealed increased performance when using ML compared to conventional statistical approaches. Moreover, the features deemed as the most relevant were concordant across the XAI methods, suggesting good stability of the results. In particular, the baseline motor impairment as measured by simple clinical scales had the largest impact, as expected. Our findings highlight the core role of ML not only for accurately predicting the individual outcome scores after rehabilitation, but also for making ML results interpretable when associated to XAI methods. This provides clinicians with robust predictions and reliable explanations that are key factors in therapeutic planning/monitoring of stroke patients.

Predictors of Functional Recovery of Upper Limb Following acute Ischemic Stroke

Background: Although age-standardised rates of stroke mortality have decreased worldwide, overall stroke burden has significantly increased over the last two and half decades especially in developing countries.Objectives: To predict the functional recovery of upper limb potential after acute ischemic stroke.Methods: 51 people were recruited and studied. SAFE, NIHS Score, Median nerve SSEP, Conventional MRI brain imaging are done for all 51 patients. 40 patients were cooperative for further DTI neuroimaging & FA value analysis done within 1wk of stroke onset. Standard care & rehabilitation given. Followed up for upper limb recovery with ARAT scores at 1st, 2nd & 3rd months. Clinical, electrophysiological and neuroimaging recovery variables of upper limb were analyzed between two groups.Results: FA asymmetry index of posterior limb of internal capsule (PLIC) suggest more structural asymmetry of PLIC and poor recovery. There is a significant negative correlation between fractional anisotropy asymmetry index and ARAT III score. Correlation coefficient (r) is -0.319.Conclusion: With initial simple clinical assessment scales most of the recovery can be predicted and thereby patient expectations can be managed and use effective targeted rehabilitation strategies, time & resources to bring the best outcome

Predicting silent atrial fibrillation in the elderly – NOMED-AF study

Abstract Background Asymptomatic (“silent”) atrial fibrillation is common and associated with poor outcomes. It is important to determine the risk factors that predispose elderly individuals from the general population to atrial fibrillation (AF). However, population-based data for silent AF (SAF) are limited. Design First, to study the risk factors for symptomatic AF and SAF in an elderly (≥65 years) general population. Second, to develop a risk stratification model for predicting SAF. Methods Continuous ECG monitoring was performed for up to 30 days using a vest-based system in a cohort from NOMED-AF, a cross-sectional study based on a nationwide population sample. The independent risk factors for AF and SAF were determined using multiple logistic regression. ROC analysis was applied to validate developed risk stratification score. Results From the total cohort of 3014 subjects, AF was diagnosed in 680 individuals (mean age, 77.5±7.9; 50.1% men) with AF, and of these, 279 (41%) had SAF. Independent associations with an increased risk of AF were age, male gender, coronary heart disease, thyroid diseases, prior ischemic stroke or transient ischemic attack (ICS/TIA), diabetes, heart failure, chronic kidney disease (CKD), obesity (BMI>30) and NT-proBNP >125 ng/ml. Prior revascularization was negatively associated with risk of AF. The main risk factors for SAF were age, male gender, prior ICS/TIA, diabetes, heart failure, CKD and NT-proBNP >125 ng/ml. We developed a simple clinical risk scale (MR-DASH score) which had good prediction in the derivation cohort (AUC 0.726) and the validation cohort (AUC 0.730). Conclusions SAF is associated with various clinical risk factors in a population sample of individuals ≥65 years. Stratifying individuals from the general population according to their risk for SAF may be possible using the MR-DASH score, facilitating targeted screening programs of individuals with high risk of SAF Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Centre for Research and Development

ПРИМЕНЕНИЕ НОВЫХ МЕТОДИК ПРИ ЛЕЧЕНИИ ПОСТРАДАВШИХ С ПЕРЕЛОМАМИ ДЛИННЫХ ТРУБЧАТЫХ КОСТЕЙ ПРИ ТЯЖЁЛОЙ СОЧЕТАННОЙ ТРАВМЕ

Severe combined injuries, and especially polytrauma, differ significantly from other types of injuries by high requirements for the organization of medical care at all its stages, miltidisciplinarity, high financial costs, poor short-term outcomes and long-term treatment results. Therefore, the search for new concepts, strategies and tactics for the treatment of victims is an urgent problem not only for surgeons, resuscitators and traumatologists, but also for healthcare in general. Fractures of long tubular bones accompanying severe combined injuries or polytrauma pose a lesser threat to the life of the victim than severe traumatic brain injuries or damage to internal organs, but they are the main cause of long-term treatment and disability. Such victims make up a significant group of patients-66.2%, therefore they represent a separate problem in traumatology and injury surgery. A modern solution to this problem, improving the results of treatment and the quality of life of victims after suffering a severe combined injury or polytrauma is possible on the basis of new approaches, as well as on the new ideology of osteosynthesis. In the present study, 392 minimally invasive osteosyntheses were performed in 274 patients with severe combined trauma and polytrauma. The indication was the need to fix fractures in order to create favorable conditions for rapid and lasting fusion, early functional treatment and rehabilitation of victims, and to achieve the highest possible level of quality of life after treatment. The possibility and duration of osteosynthesis were determined by the severity of the condition of the victims, assessed by objective methods: a simple clinical scale of VPH-SG or, much less often, specialized resuscitation scales of VPH-SS, SAPS or MODS. The surgical intervention was possible when the severity of the victim's condition reached the highest level of compensation: 16-30 points on the VPH-SG scale. The immediate outcomes of treatment of 274 patients with severe combined trauma and polytrauma after performing a full and final volume of surgery were good. There were no fatal outcomes. The frequency of mild local infectious complications in the field of surgical intervention was 4.0%. The average duration of inpatient treatment was 23.8±2.3 days: with closed intramedullary osteosynthesis - 19.8±0.3 days, with bone osteosynthesis - 24.2±1.2 days, with non - focal osteosynthesis-27.3±1.9 days. The long-term and anatomical and functional results of treatment were analyzed in 158 patients. There were no unsatisfactory long-term results of treatment. Good long-term results were achieved in 81.0%, satisfactory – in 19.0% of the victims. Thus, the results of the analysis of the immediate outcomes and long-term results of treatment of fractures of long tubular bones using the technology of minimally invasive osteosynthesis in patients with severe combined trauma and polytrauma demonstrated the high effectiveness of this surgical technology, on the one hand, and the direct dependence of the treatment outcomes on the severity of the injuries, the severity of the condition of the victims and the number of fractures in one victim, on the other hand.

POLYSUBSTANCE USE IN INFLAMMATORY BOWEL DISEASE

Abstract Background Polysubstance Use (PSU), the use of two or more substances of abuse, has been associated with increased risk for development of psychiatric conditions and early death compared to both monosubstance use or no substance use. The vast majority of clinical research on prescription or recreational drug consumption in patients with inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), has focused on use of individual substances. We evaluated the incidence and impact of PSU in IBD and assessed potential predisposing factors in this setting. Methods We performed a retrospective analysis using a consented IBD natural history registry from a single tertiary care referral center between 1/1/2015–8/31/2019. Demographics, endoscopic severity (using Mayo endoscopy sub-score for UC and Simple Endoscopic Score for CD), totals and sub-scores of surveys (Harvey-Bradshaw Index, Simple Clinical Colitis Activity Index, Hospital Anxiety and Depression Scale, Short IBD Questionnaire) assessing for symptoms (abdominal pain, fatigue, anxiety/depression, gas, diarrhea, rectal bleeding, and fecal urgency), substance use (tobacco, alcohol, marijuana, cocaine, methamphetamine, heroin, opiates, or benzodiazepine), and antidepressant or anxiolytic medication were abstracted. PSU was defined as concurrent use of two or more non-prescription drugs or substances, and healthcare resource utilization was defined as any IBD-related imaging, emergency room visit, hospitalization, or surgery over the prior 12 months. We computed descriptive statistics and performed contingency table analyses in order to identify associations between PSU and a variety of demographic and clinical characteristics. Multivariable logistic regression models were fit incorporating the clinical factors described above. Results 315 consecutively enrolled IBD patients (166f:149m; 214 CD and 101 UC) were included. Sixty-six patients (21.0%) were polysubstance users. Of these patients, 40.9% had moderate to severe disease activity, 47.0% had extra-intestinal manifestations (EIM), and 36.4% demonstrated an anxious or depressed state. EIM and antidepressant or anxiolytic use were positively associated with PSU on bivariate analysis (Table 1) and multivariable analysis (Table 2). Conclusions PSU is common in IBD, including both CD and UC. Interestingly, disease activity, IBD therapy type, and IBD-related symptoms were not associated with PSU. EIM and antidepressant or anxiolytic use were the only statistically significant predictors of PSU among patients with IBD in the multivariable logistic regression models. Our study represents the first evaluation of PSU within IBD and reinforces the importance of appropriate substance use screening among IBD patients, particularly among those with EIM and antidepressant or anxiolytic use.

Balance Problems, Paralysis, and Angina as Clinical Markers for Severity in Major Depression.

Major depressive disorder (MDD) is a heterogeneous disorder. Our hypothesis is that neurological symptoms correlate with the severity of MDD symptoms. One hundred eighty-four outpatients with MDD completed a self-report questionnaire on past and present medical history. Patients were divided into three roughly equal depression severity levels based on scores from the APA Severity Measure for Depression—Adult (n = 66, 58, 60, for low, medium, high severity, respectively). We saw a significant and gradual increase in the frequency of “muscular paralysis” (1.5–5.2–16.7%) and “balance problems” (21.2–36.2–46.6%) from low to medium to high severity groups. We repeated the analysis using only the two most extreme severity categories: low severity (66 samples) vs. high severity (60 samples). High severity patients were also found to experience more “angina” symptoms than low severity patients (27.3 vs. 50%). The three significant clinical variables identified were introduced into a binary logistic regression model as the independent variables with high or low severity as the dependent variable. Both “muscular paralysis” and “balance problems” were significantly associated with increased severity of depression (odds ratio of 13.5 and 2.9, respectively), while “angina” was associated with an increase in severity with an odds ratio of 2.0, albeit not significantly. We show that neurological exam or clinical history could be useful biomarkers for depression severity. Our findings, if replicated, could lead to a simple clinical scale administered regularly for monitoring patients with MDD.

S0840 Abdominal Pain Is Independently Associated With Healthcare Resource Utilization in Inflammatory Bowel Disease

INTRODUCTION: Several symptoms, including fatigue and abdominal pain, have been connected to increased healthcare resource utilization (HRU) in the setting of inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC). However, it is unclear whether these links are due to other key coincident clinical factors, such as disease activity. We undertook this study to investigate the incidence of IBD-associated symptoms and to determine whether any are associated with HRU. METHODS: We performed a retrospective analysis using a consented IBD natural history registry from a single tertiary care referral center between 1/1/2015 and 8/31/2019. Demographics, endoscopic severity (using Mayo endoscopy sub-score for UC and Simple Endoscopic Score for CD), totals and sub-scores of surveys (Harvey-Bradshaw Index, Simple Clinical Colitis Activity Index, Hospital Anxiety and Depression Scale, Short Inflammatory Bowel Disease Questionnaire) assessing for mild or more severe abdominal pain, fatigue, anxiety/depression, gas, IBD-associated arthralgias and dermatopathies, diarrhea, rectal bleeding, fecal urgency and tenesmus were abstracted. We performed descriptive statistics and univariate analyses [evaluating clinical factors and the incidence of HRU (defined as IBD-related imaging, emergency room, hospitalization and/or surgery over the prior 12 months) associated with each symptom], followed by logistic regression analysis (incorporating key clinical factors previously associated with HRU and the symptoms above). RESULTS: 467 consecutively enrolled IBD patients [246f:221m; 314 CD, 142 UC and 11 indeterminate colitis] were included. 174 (37.3%) patients had moderate to severe endoscopic disease activity. The most common symptoms were fatigue (83.7%), fecal urgency (68.3%) and abdominal pain (63.6%). Fatigue, abdominal pain, and opioids were each positively associated with HRU, while NSAID use was inversely associated on univariate analysis (Table 1). The only factor that demonstrated a significant association with HRU on multivariable analysis was abdominal pain (Table 2). CONCLUSION: Abdominal pain is independently associated with HRU, even when considering inflammatory activity. Abdominal pain should be specifically screened for in IBD patients to identify individuals at risk of undergoing expensive interventions. This study also reinforces the importance of appropriate diagnostic and therapeutic management of abdominal pain in IBD.Table 1Table 2

Vascular Parkinsonism (VP) score: A simple clinical scale to differentiate vascular from degenerative parkinsonism

Background: Vascular parkinsonism(VP) constitutes (5-8) % of all parkinsonian disorders. Despite several existing diagnostic criteria for VP, there is no standard clinical grading scale for VP analogous to those for vascular dementia, like the Hachinski score.

The Risk of Developing Ischemic Stroke in Patients After Exacerbation of Ischemic Heart Disease

Aim To develop a model for evaluating the risk of stroke in patients after exacerbation of ischemic heart disease who were admitted to the hospitals included into a vascular program.Materials and methods This study included 1803 patients with acute coronary syndrome (ACS) from four institutions of Moscow, Kazan, Astrakhan, and Krasnodar where the vascular program was established. Mean age of patients was 64.9±12.78 years, 62,1 % of them were men. The patients were followed up for one year after the discharge from the hospital. External validation of the developed prognostic model was performed on a cohort of patients with ACS included into the RECORD-3 study.Results During the follow-up period, 42 cases of ischemic stroke were observed. The risk of ischemic stroke was associated with the presence of atrial fibrillation (odd ratio (OR) 2.640; р=0.037), diabetes mellitus (OR 2.718; р=0.041), and chronic heart failure (OR 7.049; р=0.011). Protective factors were high-density lipoprotein cholesterol >1 mmol/l (OR 0.629; р=0.041), percutaneous coronary intervention during an index hospitalization (OR 0.412; р=0.042), anticoagulant treatment (OR 0.670; р=0.049), and achieving the blood pressure goal (OR 0.604; р=0.023). The prognostic model developed on the basis of regression analysis showed a good predictive value (area under the ROC curve, 0.780), sensitivity of 80 %, and specificity of 64.6 %. The diagnostic value of other scales for risk assessment was somewhat lower. The area under the ROC curve was 0.692±0.0245 for the GRACE scale and 0.708±0.0334 for CHA2DS2‑VASc. In the external validation of the scale based on data of the RECORD-3 study, the diagnostic value was lower although satisfactory as well (area under the ROC curve, 0.651); sensitivity was 78.9 %, and specificity was 52.3 %.Conclusion The study resulted in development of a simple clinical scale, which will probably allow identifying groups at risk of stroke more precisely than with standard scales.

Development of the Subdural Hematoma in the Elderly (SHE) score to predict mortality.

The purpose of this study was to describe the development of a novel prognostic score, the Subdural Hematoma in the Elderly (SHE) score. The SHE score is intended to predict 30-day mortality in elderly patients (those > 65 years of age) with an acute, chronic, or mixed-density subdural hematoma (SDH) after minor, or no, prior trauma. The authors used the Prognosis Research Strategy group methods to develop the clinical prediction model. The training data set included patients with acute, chronic, and mixed-density SDH. Based on multivariate analyses from a large data set, in addition to review of the extant literature, 3 components to the score were selected: age, admission Glasgow Coma Scale (GCS) score, and SDH volume. Patients are given 1 point if they are over 80 years old, 1 point for an admission GCS score of 5-12, 2 points for an admission GCS score of 3-4, and 1 point for SDH volume > 50 ml. The sum of points across all categories determines the SHE score. The 30-day mortality rate steadily increased as the SHE score increased for all SDH acuities. For patients with an acute SDH, the 30-day mortality rate was 3.2% for SHE score of 0, and the rate increased to 13.1%, 32.7%, 95.7%, and 100% for SHE scores of 1, 2, 3, and 4, respectively. The model was most accurate for acute SDH (area under the curve [AUC] = 0.94), although it still performed well for chronic (AUC = 0.80) and mixed-density (AUC = 0.87) SDH. The SHE score is a simple clinical grading scale that accurately stratifies patients' risk of mortality based on age, admission GCS score, and SDH volume. Use of the SHE score could improve counseling of patients and their families, allow for standardization of clinical treatment protocols, and facilitate clinical research studies in SDH.

Efficacy of xylazine in neonatal calves via different routes of administration

Intramuscular (IM) injections may be more aversive than subcutaneous (SC) and intra-nasal (IN) routes. Xylazine is commonly used as a sedative for cattle, but little is known about efficacy via these routes. The first aim of this study was to compare efficacy using these different routes of administration. The second aim was to determine whether a simple behavioural assessment was associated with physiological responses. Using a within-subject design, the effects of xylazine (0.2mg/kg) were assessed in 12 Holstein calves (6.2±2.8days old) administered via IM, SC, IN drip tube (IN) and IN spray (INs). Sedation was assessed on a scale based on recumbency and eyeball rotation. Heart rate (HR), respiratory rate (RR) and rectal temperature (RT) were recorded for 2h after treatment.Intramuscular and SC routes produced an equivalent mean±standard deviation (SD) onset of sedation (IM: 4.8±2.0min vs. SC: 6.8±2.2min) and duration of sedation (IM: 60.3±25.5min vs. SC: 61.9±23.3min). IN treatments produced less consistent and longer onset times (IN: 33.0±26.9min, and INs: 31.0±15.1min) and a shorter duration of sedation (IN: 42.0±31.5min, and INs: 26.7±21.8min). Behaviour scores were moderately correlated with changes in HR (r=−0.52; CI −0.60, −0.43) and changes in RR (r=−0.42; CI −0.51, −0.32), but not with changes in RT (r=−0.09, CI −0.20, 0.02). We conclude that SC is a viable alternative to the more aversive IM route, and that a simple clinical scale can be useful for assessing xylazine sedation.

Evaluation of clinical frailty screening in geriatric acute care.

While frailty status is an attractive risk stratification tool, the evaluation of frailty in acute care can be challenging as some inpatients are unable to complete performance-based tests as part of frailty assessment and some tools may lack discriminative ability and categorize majority of cohorts as "frail". In this study, we evaluated the feasibility of frailty screening with the simple clinical frailty scale (CFS) by different clinicians, and its association with mortality and rehospitalization in a geriatric acute care setting. This study took place in Geriatric Medicine Department of a General Hospital in Singapore. We analysed records of 314 inpatients aged 70years and older. At baseline, premorbid frailty was assessed using the CFS of the Canadian Study on Health and Aging. Demographic characteristics and other variables were retrieved from their medical records. Primary outcomes were mortality and rehospitalization during the 6-month follow-up. Survival analysis was used to compare the time to death and rehospitalization among CFS categories (1-4: nonfrail, 5-6: mild-moderate frail, and 7-8: severe frail). CFS showed a high inter-rater reliability when used by different clinicians. In the Cox proportional hazard model controlling for age, gender, Charlson comorbidity index, modified severity of illness index, and discharge placements, severe frailty determined by CFS (HR=2.09, 95% CI=1.01-4.33, P=0.047) and CFS scores (HR=1.27, 95% CI=1.05-1.53, P=0.012) were significantly associated with higher mortality until 6-month postdischarge, but not rehospitalization. Frailty status determined by CFS adds to disease severity and comorbidity in predicting short-term mortality but not rehospitalization in older inpatients who received geriatric acute care in our setting. CFS is reliable and has the potential to be incorporated into routine screening to better identify, communicate, and address frailty in the acute settings.

30-days’ outcome of haemorrhagic stroke: correlation between intracerebral hemorrhage score and modified Rankin score

Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes. Within 30 days reported mortality is 35-52% and only 20% is functionally independent in 6 months. Despite several existing outcome prediction models for ICH, modified Rankin scale is found to be best predictor of outcome in early and long term period. To find out 30-day mortality in ICH and predict outcome based on modified Rankin score. In this study, 48 patients presenting with acute ICH presenting to a tertiary hospital in Khulna were enrolled. The 30-day mortality and disability were recorded, and ICH score along with modified Rankin score at presentation were calculated. In this study, the 30-day mortality rate was 27.1%; regression analysis showed the correlation between the scores (as measured by modified Rankin scale) for patient disability, intraventricular hemorrhage, the Glasgow Coma score, and volume of hematoma (>30 ml vs <30 ml) were significantly correlated with corresponding ICH scores. The ICH scale is a simple clinical grading scale which can predict mortality as well as disability in haemorrhagic stroke within 30 days that can be helpful to physicians in prioritization of their patient management and forecasting about prognosis.Mediscope Vol. 5, No. 1: Jan 2018, Page 10-14

Predictors of Outcome in Patients with Pediatric Intracerebral Hemorrhage: Development and Validation of a Modified Score.

Purpose To propose and validate a modified pediatric intracerebral hemorrhage (PICH) (mPICH) score and to compare its association with functional outcome to that of the original PICH score. Materials and Methods Data from prospectively included patients were retrospectively analyzed. Consecutive patients with nontraumatic PICH who had undergone clinical follow-up were included. The study population was divided into a development cohort (2008-2012, n = 100) and a validation cohort (2013-2016, n = 43). An mPICH score was developed after variables associated with poor outcome were identified at multivariate analysis (King's Outcome Scale for Childhood Head Injury score < 5a) in the development cohort. The accuracy of the score for prediction of poor outcome was evaluated (sensitivity, specificity). Discrimination and calibration of associations between the mPICH score and poor outcome cohorts were assessed (C statistics, Hosmer-Lemeshow test). Results The mPICH score assessed as follows: brain herniation, four points; altered mental status, three points; hydrocephalus, two points; infratentorial PICH, two points; intraventricular hemorrhage, one point; PICH volume greater than 2% of total brain volume, one point. An mPICH score greater than 5 was associated with severe disability or worse, with sensitivity of 97% (95% confidence interval [CI]: 83%, 100%) and specificity of 61% (95% CI: 49%, 73%). The C statistic was 0.81 (95% CI: 0.73, 0.89). In the validation cohort, sensitivity and specificity were 95.2% (95% CI: 76%, 99%) and 77% (95% CI: 55%, 92%), respectively. There was no significant difference between the observed and predicted risks of poor outcome (P = .46). Conclusion An mPICH score was developed as a simple clinical and imaging grading scale for acute prognosis in patients with PICH. © RSNA, 2017.

Abstract 100: A Simple Bedside Grading Scale Can Effectively Predict Severe Post-stroke Upper-extremity Spasticity

Introduction: Upper-limb spasticity is a very disabling complication after stroke. There has been no simple clinical standard scale to predict spasticity immediately after stroke. This study aims to develop a simple bedside grading scale with the information collected during the acute phase to predict spasticity at 3 month post-stroke Methods: This is a prospective cohort study (Prediction and Imaging Biomarker of Post-stroke Motor Recovery) of patients with first-ever acute ischemic stroke with various degrees of motor impairment. NIH stroke scale (NIHSS) was assessed 2-7 days after onset of stroke symptoms. Modified Ashworth Spasticity Scale was used as an assessment tool in biceps, wrist flexors and finger flexors at 90 days (± 15 days) and score ≥2 at any muscle was considered as severe spasticity. Infarction volume was measured based on the lesion on MRI/DWI. Independent predictors of upper-limb spasticity at 90 days were identified by multivariate logistic regression. A risk stratification scale was developed with weighting independent predictors based on beta coefficient. Results: One hundred twenty three patients were recruited for this study. Covariates associated with upper-limb spasticity are NIHSS arm score (p&lt;0.0001), sub-cortical location (p=0.004) and lesion volume &gt;65 cc (p=0.025). The proposed grading scale is summation of individual points as followed: NIHSS Arm Score: =4 (2 point), &lt;4 (0 point); infarct location: sub-cortical (1 point), non sub-cortical (0 point); infarct volume: ≥65 cc (1 point), &lt;65cc (0 point). The rates of severe upper limb spasticity for the bedside spasticity scale, in order 0-4, are 8.9%, 29.2%, 65%, 88.7%, 96.2%. In other words, the likelihood of developing severe spasticity increases steadily using the score. Conclusion: A simple bedside grading scale can effectively predict severe post-stroke upper-limb spasticity at 90 days. Validation with an independent external dataset is a planned next step.

STUDY OF&amp;NBSP; PRONOSTIC FACTORS AFTER 30 DAYS IN PATIENTS WITH INTRACRANIAL HEMORRAGIA

Background and purpose: Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes and remains without a treatment of proven benefit. Despite several existing outcome prediction models for ICH, there is no standard clinical grading scale for ICH analogous to those for traumatic brain injury, subarachnoid hemorrhage, or ischemic stroke. Methods: Records of all patients with acute ICH presenting to the Neurology Department, Binh Dinh General Hospital from July 2014-March 2015. Clinical outcome assessed by mRankin score and was compared with each item of ICH scale. ROC-AUC was realized to evaluated the value of ICH in prognostic the outcome of cerebral hemorrhage at day 30. Results: In the day 30: mortality rate was evaluated compared with mRS: In the group with ICH 0-1: no mortality, good outcome was 92.8% and 72.7%. ICH 2-3: mortlity rate increased 47.9% and 84.4%. ICH 4-5: mortality rate 100%. The prognostic predictor of ICH was high with Se 95%, Sp 59%. ROC-AUC 0.908, p&lt;0.0001. Conclusions: The ICH Score is a simple clinical grading scale that allows risk stratification on presentation with ICH. The use of a scale such as the ICH Score could improve standardization of clinical treatment protocols and clinical research studies in ICH. Key words: Intracerebral hemorrhage (ICH), ischemic stroke

Natural history of colloid cysts of the third ventricle.

OBJECTIVE Colloid cysts are rare, histologically benign lesions that may result in obstructive hydrocephalus and death. Understanding the natural history of colloid cysts has been challenging given their low incidence and the small number of cases in most reported series. This has complicated efforts to establish reliable prognostic factors and surgical indications, particularly for asymptomatic patients with incidental lesions. Risk factors for obstructive hydrocephalus in the setting of colloid cysts remain poorly defined, and there are no grading scales on which to develop standard management strategies. METHODS The authors performed a single-center retrospective review of all cases of colloid cysts of the third ventricle treated over nearly 2 decades at Washington University. Univariate analysis was used to identify clinical, imaging, and anatomical factors associated with 2 outcome variables: symptomatic clinical status and presentation with obstructive hydrocephalus. A risk-prediction model was defined using bootstrapped logistic regression. Predictive factors were then combined into a simple 5-point clinical scale referred to as the Colloid Cyst Risk Score (CCRS), and this was evaluated with receiver-operator characteristics. RESULTS The study included 163 colloid cysts, more than half of which were discovered incidentally. More than half of the incidental cysts (58%) were followed with surveillance neuroimaging (mean follow-up 5.1 years). Five patients with incidental cysts (8.8%) progressed and underwent resection. No patient with an incidental, asymptomatic colloid cyst experienced acute obstructive hydrocephalus or sudden neurological deterioration in the absence of antecedent trauma. Nearly half (46.2%) of symptomatic patients presented with hydrocephalus. Eight patients (12.3%) presented acutely, and there were 2 deaths due to obstructive hydrocephalus and herniation. The authors identified several factors that were strongly correlated with the 2 outcome variables and defined third ventricle risk zones where colloid cysts can cause obstructive hydrocephalus. No patient with a lesion outside these risk zones presented with obstructive hydrocephalus. The CCRS had significant predictive capacity for symptomatic clinical status (area under the curve [AUC] 0.917) and obstructive hydrocephalus (AUC 0.845). A CCRS ≥ 4 was significantly associated with obstructive hydrocephalus (p < 0.0001, RR 19.4). CONCLUSIONS Patients with incidentally discovered colloid cysts can experience both lesion enlargement and symptom progression or less commonly, contraction and symptom regression. Incidental lesions rarely cause acute obstructive hydrocephalus or sudden neurological deterioration in the absence of antecedent trauma. Nearly one-half of patients with symptomatic colloid cysts present with obstructive hydrocephalus, which has an associated 3.1% risk of death. The CCRS is a simple 5-point clinical tool that can be used to identify symptomatic lesions and stratify the risk of obstructive hydrocephalus. External validation of the CCRS will be necessary before objective surgical indications can be established. Surgical intervention should be considered for all patients with CCRS ≥ 4, as they represent the high-risk subgroup.

Primary Pontine Hemorrhage in the Acute Stage: Clinical Features and a Proposed New Simple Scoring System

It is important to evaluate the likelihood of fatality in patients with acute primary pontine hemorrhage (PPH) in emergency departments. We aimed to evaluate the clinical symptoms and computed tomography findings of PPH to develop a simple grading scale for predicting the mortality of PPH. Records of 101 consecutive patients admitted to our hospital with acute PPH between June 1, 2006, and January 31, 2014, were retrospectively reviewed. Independent predictors of 30-day mortality were identified by univariate and multivariate logistic regression analyses. A simple and easy clinical score (PPH score) was developed from independent factors to predict mortality in acute PPH. The PPH score was compared with the established intracerebral hemorrhage (ICH) score, which served as the reference scoring system. Overall mortality rate 30days after onset was 58.4% (59 of 101). Factors independently associated with 30-day mortality were Glasgow Coma Scale (GCS) score of 6 or less (P=.0051), absence of pupillary light reflex (P=.0003), and blood glucose of 180mg/dL or greater (P=.0312). The PPH score was the sum of independent factors, which were assigned 1 point each. The area under the receiver operating characteristic curve for predicting 30-day mortality was .90 (95% confidence interval [CI], .84-.95) for PPH score and .86 (95% CI, .78-.93) for ICH score. GCS score of 6 or less, absence of pupillary light reflex, and plasma glucose of 10mmol/L or greater are independent mortality predictors of PPH. The PPH score is a simple and reliable clinical grading scale for predicting 30-day mortality.

Paracetamol induced fi xed drug eruptions: A case report

To report a case of fi xed drug eruption (FDE) due to paracetamol intake. FDE is cutaneous reactions in already sensitized individuals. The characteristic of FDE is recurrence at same site on repeated insults with the off ending drug. Paracetamol induced FDE is widely reported in children and adolescents but not among elderly individuals. A 62-year-old male patient had a chief complaint of burning sensation in lips and oral cavity since 3 days. History revealed intake of paracetamol. Encrusted lesions were present on the cutaneous surfaces of lips, and erythematous areas were present on the anterior third of the hard palate. Based on Naranjo’s casualty assessment scale, provisional diagnosis of adverse drug reaction (ADR) was given. All drugs were stopped, but the patient had a similar episode of such lesions on the same site after 8 weeks. This establishes the diagnosis of FDE due to paracetamol ingestion. Though paracetamol is widely used and is considered a safe drug, ADR to it are possible and reported earlier. Clinical signifi cance: Reporting of FDE to dentist is uncommon. But on encountering such a situation, the dentist should be able to identify FDE and isolate the causative drug by means of history. A simple clinical assessment scale like Naranjo’s casualty assessment scale can establish the presence of ADR.