Pediatric Intracerebral Hemorrhage Score: A Simple Grading Scale for Intracerebral Hemorrhage in Children

• Published in: Stroke (1970) 2014-01, Vol.45 (1), p.66-70
• Main Authors: BESLOW, Lauren A, ICHORD, Rebecca N, GINDVILLE, Melissa C, KLEINMAN, Jonathan T, ENGELMANN, Kyle, BASTIAN, Rachel A, LICHT, Daniel J, SMITH, Sabrina E, HILLIS, Argye E, JORDAN, Lori C
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Biological and medical sciences; Brain - anatomy & histology; Cerebral Hemorrhage - mortality; Cerebral Hemorrhage - pathology; Cerebral Hemorrhage - surgery; Cerebral Ventricles - pathology; Child; Child, Preschool; Cohort Studies; Disability Evaluation; Drug toxicity and drugs side effects treatment; Female; Humans; Hydrocephalus - complications; Infant; Infant, Newborn; Male; Medical sciences; Neurology; Neurosurgical Procedures; Pharmacology. Drug treatments; Predictive Value of Tests; Prognosis; Prospective Studies; Recovery of Function; ROC Curve; Sex Factors; Toxicity: nervous system and muscle; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.113.003448

The intracerebral hemorrhage (ICH) score is the most commonly used clinical grading scale for outcome prediction after adult ICH. We created a similar scale in children to inform clinical care and assist in clinical research. Children, full-term newborns to 18 years, with spontaneous ICH were prospectively enrolled from 2007 to 2012 at 3 centers. The pediatric ICH score was created by identifying factors associated with poor outcome. The score's ability to detect moderate disability or worse and severe disability or death was examined with sensitivity, specificity, and area under the receiver operating characteristic curve. The pediatric ICH score components include ICH volume>2% to 3.99% of total brain volume (TBV): 1 point; ICH volume≥4% TBV: 2 points; acute hydrocephalus: 1 point; herniation: 1 point; and infratentorial location: 1 point. The score ranges from 0 to 5. At 3-month follow-up of 60 children, 10 were severely disabled or dead, 30 had moderate disability, and 20 had good recovery. A pediatric ICH score≥1 predicted moderate disability or worse with a sensitivity of 75% (95% confidence interval [CI], 59% to 87%) and a specificity of 70% (95% CI, 46% to 88%). A pediatric ICH score≥2 predicted severe disability or death with a sensitivity and specificity of 90% (95% CI, 55% to 99%) and 68% (95% CI, 53% to 80%), respectively. The area under the receiver operating characteristic curve for classifying outcome as severe disability or death was 0.88 (95% CI, 0.78-0.97). The pediatric ICH score is a simple clinical grading scale that may ultimately be used for risk stratification, clinical care, and research.