Supplementary Material for: Refining Prognosis for Intracerebral Hemorrhage by Early Reassessment

Background: Prognostic assessments, which are crucial
for decision-making in critical illnesses, have shown unsatisfactory
reliability. We compared the accuracy of a widely used prognostic score
against a model derived from clinical data obtained 5 days after
admission for patients with intracerebral hemorrhage (ICH), a condition
for which prognostication has proven notoriously challenging and prone
to bias. Methods: Patients enrolled in a prospective
observational cohort study of spontaneous ICH underwent hourly Glasgow
Coma Scale (GCS) assessment. Outcome was measured at 3 months using the
modified Rankin Scale (mRS). We analyzed the change in correlation
between GCS and 3-month mRS scores from admission through day 5, and
compared the performance of a parsimonious set of day 5 clinical
variables against the ICH score. Results: Data was collected on 254 subjects. The ICH score and day 5 GCS score were both correlated with 3-month mRS score (p < 0.001), but the correlation was stronger with day 5 GCS score (p
< 0.05 by Fisher z-transformation). Premorbid mRS score,
intraventricular hemorrhage and day 5 GCS score were independent
predictors of outcome (all p < 0.05 in ordinal regression
model). While ICH score correctly classified good (mRS 0-3) vs. poor
(mRS 4-6) outcome in 73% of cases, the day 5 model correctly classified
83% of cases. Conclusions: A simple reassessment after 5
days of care significantly improves the accuracy of prognosticating
outcome in patients with ICH. These data confirm the feasibility and
potential utility of early reassessments in refining prognosis for
patients who survive early stabilization of a severe neurologic injury.

背景：预后评估对于重症疾病决策至关重要，但其可靠性一直不尽人意。本研究对比了一种广泛使用的预后评分与从患者入院后5天收集的临床数据中衍生出的模型，该模型针对的是颅内出血（ICH）这一预后评估历来极具挑战性且易受偏差影响的疾病。方法：纳入了一项前瞻性观察队列研究，对自发性ICH患者进行了每小时格拉斯哥昏迷评分（GCS）的评估。预后在3个月时使用改良的Rankin量表（mRS）进行测量。我们分析了从入院到第5天GCS评分与3个月mRS评分之间相关性的变化，并将第5天一组简洁的临床变量与ICH评分的性能进行了比较。结果：收集了254名受试者的数据。ICH评分和第5天GCS评分均与3个月mRS评分呈正相关（p < 0.001），但与第5天GCS评分的相关性更强（通过Fisher z变换，p < 0.05）。前驱期mRS评分、脑室内出血和第5天GCS评分是预后的独立预测因素（在序数回归模型中所有p < 0.05）。虽然ICH评分在73%的情况下正确分类了良好（mRS 0-3）与不良（mRS 4-6）的预后，但第5天模型在83%的情况下正确分类了预后。结论：在5天治疗后进行简单复评显著提高了ICH患者预后评估的准确性。这些数据证实了早期复评在改善经早期稳定严重神经系统损伤后生存患者的预后方面的可行性和潜在效用。