Grave Prognosis on Spontaneous Intracerebral Haemorrhage: GP on Stage Score Niphon Poungvarin MD, FRCP*, Nijasri C Suwanwela MD**, Narayanaswamy Venketasubramanian MD***, Lawrence KS Wong MD****, Jose C Navarro MD*****, Ester Bitanga MD******, Byung Woo Yoon MD*******, Hui M Chang MD********, Sardar M Alam MD*********, for the Asian Stroke Advisory Panel (ASAP)1
* Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Neurological Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand *** Department of Neurology, Co-ordinator, Stroke Programme, Co-Head, Neurorehabilitation Unit, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore **** Department of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ***** Department of Medicine, University of Santo Thomas Hospital, Espana, Manila, Philippines ****** University of the Philippines, Philippines General Hospital, Taft Avenue, Ermita Chair, Manila, Philippines ******* Department of Neurology, Seoul National University Hospital, 28, Yongon-dong, Chongno-gu, Seoul, Korea ********Department of Neurology, Singapore General Hospital, Outram Road, Singapore *********Rehman Medical Institute, Phase V Hayatabad, Peshawar, Pakistan
Affiliation : Background and Objective : Spontaneous intracerebral haemorrhage (ICH) is more common in Asia than in
western countries, and has a high mortality rate. A simple prognostic score for predicting grave prognosis of
ICH is lacking. Our objective was to develop a simple and reliable score for most physicians.
Materials and Methods : ICH patients from seven Asian countries were enrolled between May 2000 and April
2002 for a prospective study. Clinical features such as headache and vomiting, vascular risk factors, Glasgow
coma scale (GCS), body temperature (BT), blood pressure on arrival, location and size of haematoma, intra-
ventricular haemorrhage (IVH), hydrocephalus, need for surgical treatment, medical treatment, length of
hospital stay and other complications were analyzed to determine the outcome using a modified Rankin scale
(MRS). Grave prognosis (defined as MRS of 5-6) was judged on the discharge date.
Results : 995 patients, mean age 59.5+14.3 years were analyzed, after exclusion of incomplete data in 87
patients. 402 patients (40.4%) were in the grave prognosis group (MRS 5-6). Univariable analysis and then
multivariable analysis showed only four statistically significant predictors for grave outcome of ICH. They
were fever (BT> 37.8oc), low GCS, large haematoma and IVH. The grave prognosis on spontaneous
intracerebral haemorrhage (GP on STAGE) score was derived from these four factors using a multiple logistic
model.
Conclusion : A simple and pragmatic prognostic score for ICH outcome has been developed with high
sensitivity (82%) and specificity (82%). Furthermore, it can be administered by most general practitioners.
Validation in other populations is now required.
Keywords : Cerebral haemorrhage, Stroke, Cerebrovascular disease, Intracerebral haemorrhage, Prognostic cerebral haemorrhage score
