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On-line version ISSN 1678-4227
Arq. Neuro-Psiquiatr. vol.56 n.4 São Paulo Dec. 1998
CLINICAL DISCRIMINATORS BETWEEN ACUTE BRAIN HEMORRHAGE AND INFARCTION: A PRACTICAL SCALE FOR EARLY PATIENT IDENTIFICATION (ABSTRACT)*. THESIS. SÃO PAULO, 1998.
AYRTON ROBERTO MASSARO **
New treatments for acute stroke require a rapid triage system which minimizes treatment delays and maximizes selection of eligible patients. Our aim was to create a score for assessing the probability of brain hemorrhage among patients with acute stroke based upon simple, clinical information available prior to hospitalization.
Of 1805 patients with acute stroke in the Stroke Data Bank (SDB), 1273 had infarction (INF) and 237 had parenchymatous hemorrhage (HEM) verified by CT. INF and HEM discriminators were determined by logistic regression and used to create a score. Receiver operating characteristic curve was used to maximize sensitivity and specificity of HEM.
The SDB score components favoring HEM over INF were men, those presenting with severe headache, vomiting, coma or decreased consciousness, an initial blood pressure > 220/120 mmHg, or if one or more than one of the clinical variables were unmeasurable. Age >55, history of angina, prior stroke or TIA, diabetes, deficit upon awakening, and presentation with a focal deficit gave score favoring INF. For predicting HEM (SDB score < 2), sensitivity was 76% and specificity was 83% in the SDB cohort.
Use of a practical validated score by emergency personnel can help to select patients for stroke trials and pre-hospital treatments, alert CT scan technicians, and warn stroke teams of incoming patients to reduce treatment delays.
KEY WORDS: cerebrovascular disorders, cerebral hemorrhage, cerebral ischemia.
*Proposta de uma nova escala de avaliação clínica para o diagnóstico diferencial entre acidente vascular cerebral isquêmico e hemorrágico (Resumo). Tese de Doutorado, Faculdade de Medicina da Universidade de São Paulo - FMUSP (Área: Neurologia). Orientador: Milberto Scaff.
**Address: Clínica Neurológica do Hospital das Clínicas da FMUSP, Av. Dr. Enéas de Carvalho Aguiar 255 / 5o. andar, 05403-000 São Paulo SP, Brasil.