Early neurological worsening is a major determinant of death in spontaneous intracerebral hemorrhage. In recent years, several clinical grading scales have been developed to identify patients at risk of 30-day or 90-day poor outcome following spontaneous , but whether these are able to predict ENW remains unclear. The aim of our study was to validate and compare two ICH grading scales for predicting ENW. Original (o) ICH and FUNC scores were calculated for 128 consecutive, prospectively-collected ICH patients using components and cutoff values identical to those described in the original derivation cohorts. Receiver operating characteristic (ROC) analysis, including area under the curve, was used to assess the ability of each score to predict ENW. Overall, thirty-day mortality rate was 33.6% (n=43), while only 19 (15.3%) patients had good outcome at 90-days. ENW was evident in 40 patients. Compared with patients without ENW, patients with ENW had significantly higher in-hospital mortality (79.1% vs 5%, p=0.0001), mortality within 48 hours (56.5% vs 0%,p=0.0001), baseline hematoma volume greater than 30 mm3(85.4% vs 20%, p=0.0001), baseline intraventricular bleeding (83% vs 16.25%, p=0.0001), hematoma enlargement in second brain CT (34% vs 2.5%, p=0.0001),history of vitamin K antagonists or antiplatelet treatment (75% vs 46.25%, p=0.001), lower median Glasgow Coma Scale at baseline (9.5 vs 15, p=0.001), higher median oICH score at baseline (4 vs 1, p=0.001), lower FUNC score at baseline (4.5 vs 8, p=0.001). Both scores were accurate predictors of study outcomes demonstrating excellent discrimination (AUC>0.80). However, oICH score permitted a correct ENW risk reclassification in 26% of patients. Deciding the appropriate level of medical care to offer ICH patients in the acute phase can be difficult and approaches vary likely influenced by the views of the clinician and patient (or the patient’s next of kin) regarding prognosis. Despite the availability of validated prognostic scores, such tools remain underutilized, in part because of their multiplicity. However, there are several potential benefits of prognostic scores. Prediction of ENW was not examined in the derivation cohorts for the oICH and FUNC scores, therefore our aim was to test the hypothesis that the oICH and FUNC scores would predict ENW and to compare their performance in an unselected sample of consecutive ICH patients.

With Regards,
Sara Giselle
Associate Managing Editor
Journal of Stroke Research & Therapy