22. European Stroke Conference 595 Acute stroke: emergency management, stroke units and complications Safe Implementation of Treatments in Stroke Symptomatic Intracerebral Hemorrhage Risk Score (SITS - SICH) among patients of SETIS Register P. Stanarcevic1, M. Stefanovic Budimkic2, V. Padjen3, I. Berisavac4, M. Ercegovac5, Lj. Beslac Bumbasirevic6, D.R. Jovanovic7 Department of Emergency Neurology, Neurology Clinic, Clinical Center of Serbia, Belgrade, SERBIA1, Department of Emergency Neurology, Neurology Clinic, Clinical Center of Serbia, Bel-grade, SERBIA2, Department of Emergency Neurology, Neurology Clinic, Clinical Center of Serbia, Belgrade, SERBIA3, Department of Emergency Neurology, Neurology Clinic, Clinical Center of Serbia, Belgrade, SERBIA4, Department of Emergency Neurology, Neurology Clinic, Clinical Cen-ter of Serbia; Medical Faculty, University of Belgrade, Belgrade, SERBIA5, Department of Emer-gency Neurology, Neurology Clinic, Clinical Center of Serbia; Medical Faculty, University of Bel-grade, Belgrade, SERBIA6, Department of Emergency Neurology, Neurology Clinic, Clinical Center of Serbia; Medical Faculty, University of Belgrade, Belgrade, SERBIA7 Background: Recently a new clinical scoring system was proposed from Safe Implementation of Treatments in Stroke (SITS) Investigators for prediction of risk of symptomatic intracerebral hemor-rhage (SICH) after thrombolysis. Aim of our study was to assess the effectiveness and usefulness in our population of patients treated with thrombolytic therapy. Methods: We analyzed data from 761 patients enrolled in our national Serbian Expirience with Thrombolysis in Ischemic Stroke (SETIS) register. The primary outcome measure was occurence of SICH, defined according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition. Initially, all patients were scored according to SITS SICH scoring system and divided in four groups depending on overall risk level, as suggested by SITS Investigators (Low, Average, Moderate and High Risk), followed by correlation of groups with occurence of SICH. Results: The overall rate of SICH was 3%. The median total SITS SICH score in our cohort was 4 (IQR 3 - 5), while maximal score was 9, registered in only 3 patients. Distribution of patients in groups according to overall risk level and occurence of SICH is shown in Table 1. Interestingly, in High Risk Level group there were no cases of SICH, but this could be adressed to relativelly small sample size and small number of patients in this group (only three). Analysis showed sigificant in-crease of risk for SICH in patients scored 6 or more points, with SICH rate of 5,3%, raising to 5,9% in patients scored 7 or more points. Conversely, in group of patient scored with 0 points, there were no cases of SICH, while patients with total risk score of 1 had SICH rate of 2,7%. Conclusion: SITS SICH score is effective and usefull in helping identifying patients in high risk for occurence of SICH after intravenous thrombolytic therapy. Table 1: Distribution of patients according to Overall risk level and occurence of SICH Overall Risk Level 660 © 2013 S. Karger AG, Basel Scientific Programme Total cohort (N = 761) SICH (N = 23) SICH Rate Low 155 3 1,93% Average 433 11 2,54% Moderate 170 9 5,29% High 3 0 0 SICH indicates Symptomatic Intracerebral Hemorrhage 596 Acute stroke: emergency management, stroke units and complications Prediction capability of the ’Stroke Prognostication using Age and NIH Stroke Scale (SPAN- 100)’ in the SITS- International Stroke Thrombolysis Register N. Ahmed1, G.A. Ford2, K.R. Lees3, R. Mikulik4, T. Tatlisumak5, D. Toni6 Department of Clinical Neurosciences, Karolinska Institutet, Karolinska University Hospi-tal, Stockholm, SWEDEN1, Institute for Ageing and Health, Newcastle University, Newcastle, UNITED KINGDOM2, Department of Medicine and Therapeutics, Gardiner Institute, University of Glasgow, Glasgow, UNITED KINGDOM3, Neurology Department, International Clinical Research Center, St Anne’s Hospital, Brno, Brno, CZECH REPUBLIC4, Department of Neurology, Helsinki University Central Hospital, Helsinki, Helsinki, FINLAND5, Department of Neurology, Department of Neurological Sciences, La Sapienza University Hospital, Rome, Rome, ITALY6 BACKGROUND: The SPAN-100 is a recent score using NINDS intravenous (IV) thrombolysis trial dataset for pre-diction of outcome after acute ischaemic stroke. In SPAN-100, age in years is added to NIH stroke scale (NIHSS) score. SPAN-100 positive (Index>=100) patients had higher intracerebral haemor-rhage (ICH) rates and worse outcome than SPAN<100. We aimed to evaluate this score in the SITS- International Stroke Thrombolysis Register (ISTR). METHODS: 44302 patients, prospectively recorded in the SITS-ISTR, were classified according to the SPAN in-dex. Outcome measures were symptomatic ICH (SICH), mortality, no/minimal disability (modified Rankin Scale, mRS 0-1) and functional independence (mRS 0-2) at 3 months. Bivariate and mul-tivariable logistic regression analyses were performed to assess the association of SPAN-100 with outcomes. RESULTS: 3320 (7.4%) patients were SPAN-100 positive. Median age was 83 vs. 69 years (p<0.001) and NI-HSS 21 vs. 11 (p<0.001) for SPAN-100 positive compared with SPAN<100 patients. SPAN-100 positive patients had higher SICH rates (2.3% vs. 1.7%, p=0.009 per SITS-MOST and 13.2% vs.7%, p<0.001 per NINDS) and mortality (48% vs. 12%, p<0.001), lower no/minimal disability (8% vs. 42%, p<0.001) and functional independence (15% vs. 58%, p<0.001) than SPAN<100 patients. In multivariable analyses, SPAN-100 positive patients had a higher odds ratio (OR) for mortality (1.15, 95% CI 1.03-1.3), lower OR for no/minimal disability (0.79, 0.67-0.94) but similar OR functional independence (0.97, 0.84-1.11) and lower OR for SICH than SPAN<100 patients (0.57, 0.42-0.77, for SITS-MOST, 0.72, 0.63-0.84 for NINDS). CONCLUSION: As anticipated from older age and higher NIHSS, the SPAN-100 predicted unadjusted outcome in SITS-ISTR dataset but, when adjusted for baseline imbalances, the SPAN-100 did neither pre-dict SICH nor functional independence. Our results do not support withholding IV thrombolysis in SPAN-100 positive patients who otherwise fulfil treatment criteria.
Karger_ESC London_2013
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