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Response to the Letter to the Editor from Gustavo Cartaxo Patriota, M.D., M.Sc., on “Clinical Grading Scales in Intracerebral Hemorrhage”

By Currents Editor posted 02-11-2019 14:29


By Brian Y. Hwang, Geoffrey Appelboom, Christopher P. Kellner, E. Sander Connolly Jr.

Dear Editor,

The original intracerebral hemorrhage (oICH) score is one of the most commonly used intracerebral hemorrhage (ICH) clinical grading scales [1]. The score has been shown to be a good predictor of 30-day mortality and functional outcome in populations with distinct geographical, cultural, and socioeconomic factors [2]. Nevertheless, the oICH score’s limitations have led many studies to develop either modified versions of the score or new clinical grading scales in efforts to improve risk-stratification and outcome prediction after ICH.

With many grading scales available, it is becoming increasingly difficult to determine which scales offer optimal predictability and reliability. Expeditious identification and/or development of the best grading scale(s) would be critical for clinicians, patients, and researchers alike. In the absence of studies that directly compare all the scales, we have initially attempted to compare them head-to-head based on the information provided in individual studies. However, significant discrepancies in inclusion/exclusion criteria, study design, and outcome measures among the studies rendered the comparison challenging and results potentially misleading. Thus, we have discussed the critical issues regarding the development, validation, and comparison of ICH grading scales in our article in hopes that future studies will be undertaken to conclusively determine the best ICH grading scale(s) [3].

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