Oxfordshire community stroke project classification improves prediction of post-thrombolysis symptomatic intracerebral hemorrhage

Sheng Feng Sung, Solomon Chih Cheng Chen, Huey Juan Lin, Chih-Hung Chen, Mei Chiun Tseng, Chi Shun Wu, Yung Chu Hsu, Ling Chien Hung, Yu Wei Chen

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: The Oxfordshire Community Stroke Project (OCSP) classification is a simple stroke classification system with value in predicting clinical outcomes. We investigated whether and how the addition of OCSP classification to the Safe Implementation of Thrombolysis in Stroke (SITS) symptomatic intracerebral hemorrhage (SICH) risk score improved the predictive performance.Methods: We constructed an extended risk score by adding an OCSP component, which assigns 3 points for total anterior circulation infarcts, 0 point for partial anterior circulation infarcts or lacunar infarcts. Patients with posterior circulation infarcts were assigned an extended risk score of zero. We analyzed prospectively collected data from 4 hospitals to compare the predictive performance between the original and the extended scores, using area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI).Results: In a total of 548 patients, the rates of SICH were 7.3% per the National Institute of Neurological Diseases and Stroke (NINDS) definition, 5.3% per the European-Australasian Cooperative Acute Stroke Study (ECASS) II, and 3.5% per the SITS-Monitoring Study (SITS-MOST). Both scores effectively predicted SICH across all three definitions. The extended score had a higher AUC for SICH per NINDS (0.704 versus 0.624, P = 0.015) and per ECASS II (0.703 versus 0.612, P = 0.016) compared with the SITS SICH risk score. NRI for the extended risk score was 22.3% (P = 0.011) for SICH per NINDS, 21.2% (P = 0.018) per ECASS II, and 24.5% (P = 0.024) per SITS-MOST.Conclusions: Incorporation of the OCSP classification into the SITS SICH risk score improves risk prediction for post-thrombolysis SICH.

Original languageEnglish
Article number39
JournalBMC Neurology
Volume14
Issue number1
DOIs
Publication statusPublished - 2014 Mar 1

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Cerebral Hemorrhage
Stroke
Area Under Curve
Lacunar Stroke
ROC Curve

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Sung, Sheng Feng ; Chen, Solomon Chih Cheng ; Lin, Huey Juan ; Chen, Chih-Hung ; Tseng, Mei Chiun ; Wu, Chi Shun ; Hsu, Yung Chu ; Hung, Ling Chien ; Chen, Yu Wei. / Oxfordshire community stroke project classification improves prediction of post-thrombolysis symptomatic intracerebral hemorrhage. In: BMC Neurology. 2014 ; Vol. 14, No. 1.
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title = "Oxfordshire community stroke project classification improves prediction of post-thrombolysis symptomatic intracerebral hemorrhage",
abstract = "Background: The Oxfordshire Community Stroke Project (OCSP) classification is a simple stroke classification system with value in predicting clinical outcomes. We investigated whether and how the addition of OCSP classification to the Safe Implementation of Thrombolysis in Stroke (SITS) symptomatic intracerebral hemorrhage (SICH) risk score improved the predictive performance.Methods: We constructed an extended risk score by adding an OCSP component, which assigns 3 points for total anterior circulation infarcts, 0 point for partial anterior circulation infarcts or lacunar infarcts. Patients with posterior circulation infarcts were assigned an extended risk score of zero. We analyzed prospectively collected data from 4 hospitals to compare the predictive performance between the original and the extended scores, using area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI).Results: In a total of 548 patients, the rates of SICH were 7.3{\%} per the National Institute of Neurological Diseases and Stroke (NINDS) definition, 5.3{\%} per the European-Australasian Cooperative Acute Stroke Study (ECASS) II, and 3.5{\%} per the SITS-Monitoring Study (SITS-MOST). Both scores effectively predicted SICH across all three definitions. The extended score had a higher AUC for SICH per NINDS (0.704 versus 0.624, P = 0.015) and per ECASS II (0.703 versus 0.612, P = 0.016) compared with the SITS SICH risk score. NRI for the extended risk score was 22.3{\%} (P = 0.011) for SICH per NINDS, 21.2{\%} (P = 0.018) per ECASS II, and 24.5{\%} (P = 0.024) per SITS-MOST.Conclusions: Incorporation of the OCSP classification into the SITS SICH risk score improves risk prediction for post-thrombolysis SICH.",
author = "Sung, {Sheng Feng} and Chen, {Solomon Chih Cheng} and Lin, {Huey Juan} and Chih-Hung Chen and Tseng, {Mei Chiun} and Wu, {Chi Shun} and Hsu, {Yung Chu} and Hung, {Ling Chien} and Chen, {Yu Wei}",
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Oxfordshire community stroke project classification improves prediction of post-thrombolysis symptomatic intracerebral hemorrhage. / Sung, Sheng Feng; Chen, Solomon Chih Cheng; Lin, Huey Juan; Chen, Chih-Hung; Tseng, Mei Chiun; Wu, Chi Shun; Hsu, Yung Chu; Hung, Ling Chien; Chen, Yu Wei.

In: BMC Neurology, Vol. 14, No. 1, 39, 01.03.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Oxfordshire community stroke project classification improves prediction of post-thrombolysis symptomatic intracerebral hemorrhage

AU - Sung, Sheng Feng

AU - Chen, Solomon Chih Cheng

AU - Lin, Huey Juan

AU - Chen, Chih-Hung

AU - Tseng, Mei Chiun

AU - Wu, Chi Shun

AU - Hsu, Yung Chu

AU - Hung, Ling Chien

AU - Chen, Yu Wei

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N2 - Background: The Oxfordshire Community Stroke Project (OCSP) classification is a simple stroke classification system with value in predicting clinical outcomes. We investigated whether and how the addition of OCSP classification to the Safe Implementation of Thrombolysis in Stroke (SITS) symptomatic intracerebral hemorrhage (SICH) risk score improved the predictive performance.Methods: We constructed an extended risk score by adding an OCSP component, which assigns 3 points for total anterior circulation infarcts, 0 point for partial anterior circulation infarcts or lacunar infarcts. Patients with posterior circulation infarcts were assigned an extended risk score of zero. We analyzed prospectively collected data from 4 hospitals to compare the predictive performance between the original and the extended scores, using area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI).Results: In a total of 548 patients, the rates of SICH were 7.3% per the National Institute of Neurological Diseases and Stroke (NINDS) definition, 5.3% per the European-Australasian Cooperative Acute Stroke Study (ECASS) II, and 3.5% per the SITS-Monitoring Study (SITS-MOST). Both scores effectively predicted SICH across all three definitions. The extended score had a higher AUC for SICH per NINDS (0.704 versus 0.624, P = 0.015) and per ECASS II (0.703 versus 0.612, P = 0.016) compared with the SITS SICH risk score. NRI for the extended risk score was 22.3% (P = 0.011) for SICH per NINDS, 21.2% (P = 0.018) per ECASS II, and 24.5% (P = 0.024) per SITS-MOST.Conclusions: Incorporation of the OCSP classification into the SITS SICH risk score improves risk prediction for post-thrombolysis SICH.

AB - Background: The Oxfordshire Community Stroke Project (OCSP) classification is a simple stroke classification system with value in predicting clinical outcomes. We investigated whether and how the addition of OCSP classification to the Safe Implementation of Thrombolysis in Stroke (SITS) symptomatic intracerebral hemorrhage (SICH) risk score improved the predictive performance.Methods: We constructed an extended risk score by adding an OCSP component, which assigns 3 points for total anterior circulation infarcts, 0 point for partial anterior circulation infarcts or lacunar infarcts. Patients with posterior circulation infarcts were assigned an extended risk score of zero. We analyzed prospectively collected data from 4 hospitals to compare the predictive performance between the original and the extended scores, using area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI).Results: In a total of 548 patients, the rates of SICH were 7.3% per the National Institute of Neurological Diseases and Stroke (NINDS) definition, 5.3% per the European-Australasian Cooperative Acute Stroke Study (ECASS) II, and 3.5% per the SITS-Monitoring Study (SITS-MOST). Both scores effectively predicted SICH across all three definitions. The extended score had a higher AUC for SICH per NINDS (0.704 versus 0.624, P = 0.015) and per ECASS II (0.703 versus 0.612, P = 0.016) compared with the SITS SICH risk score. NRI for the extended risk score was 22.3% (P = 0.011) for SICH per NINDS, 21.2% (P = 0.018) per ECASS II, and 24.5% (P = 0.024) per SITS-MOST.Conclusions: Incorporation of the OCSP classification into the SITS SICH risk score improves risk prediction for post-thrombolysis SICH.

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