External Validation of The Symptomatic Intracranial Hemorrhage Score Predicts Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke Patients at Nakornping Hospital

Abstract

Intracerebral hemorrhage is the most serious complication of stroke thrombolysis. The Symptomatic Intracranial Hemorrhage Score (SICH score) predicts an individual risk of symptomatic intracranial
hemorrhage (sICH) after intravenous thrombolysis in Thai patients. The SICH score comprised of valvular heart diseases, use of aspirin, systolic blood pressure prior to thrombolysis of 140 mmHg or higher, NIHSS
scores higher than 20 and higher than 10, platelet count lower than 250,000 cell/mm3, and use of  Intravenous antihypertensive drugs during thrombolysis.The aim of this study was to external validation of SICH score predicts symptomatic intracranial hemorrhage after intravenous thrombolysis in acute ischemic stroke patients at Nakornping hospital and identify independent factors associated with sICH. Retrospective data were reviewed between 1 June 2014 – 31 May 2018. The study included 119 patients with acute ischemic stroke who were treated with intravenous thrombolysis. There were asymptomatic intracranial hemorrhage 18.5% (n = 22), symptomatic intracranial hemorrhage 10.1% (n = 12), hemorrhagic infarction type1 9.2% (n = 11),hemorrhagic infarction type2 7.6% (n = 9), Parenchymal hematoma type1 5% (n = 6), parenchymal hematoma type2 5.9% (n = 7) and other type 0.8% (n = 1). There were not independent risk factors for sICH. External validation of SICH score was sensitivity 73.5 (95% CI, 55.6-87.1), specificity 36.9 (95% CI, 26.6-48.1), AUC-ROC 0.52 (95% CI, 0.46-0.64), odds ratio 1.62 (95% CI, 0.68-3.86), positive predictive value 32.1 (95% CI, 21.9-43.6) and negative predictive value 77.5 (95% CI, 61.5-89.2). The SICH score could not predict sICH after intravenous Thrombolysis in acute ischemic stroke patients at Nakornping hospital. Limitation of this study was small sample size