Abstract Details

Title Validation of the AHA-GWTG/GRASPS Scoring in Prediction of Symptomatic Intracerebral Hemorrhage in Acute Ischemic Stroke Patients Receiving Intravenous TissueType Plasminogen Activator

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 227

Objective

Background BACKGROUND: The recently developed GRASPS score predicts risk for symptomatic intracerebral hemorrhage (sICH) within 36 hours post intravenous tissue plasminogen activator (iv-tPA) infusion. In the original study, sICH adjudication was based on documentation but neuroimaging was not centrally available.

Design/Methods DESIGN/METHODS: Consecutive acute ischemic stroke (AIS) patients admitted to our institutions between January 2011 and July 2012, and treated with iv-tPA were identified. Age, race/ethnicity, sex, NIHSS, blood pressure, and glycemia at presentation were obtained, and GRASPS scores calculated. Charts were reviewed looking for neurological deterioration and sICH at 36h post iv-tPA infusion. Neuroimaging was used to confirm the diagnosis of sICH. Scores were analyzed for sensitivity and specificity and the C-statistic calculated based on the receiver operating characteristic (ROC) curve.

Results RESULTS: A total of 41 cases treated with iv-tPA within 3 hours of symptom onset were identified and analyzed. Our study population was predominantly white (73.2%), male (54%), with a median age of 79±13 years, and median NIHSS of 14±8 at baseline. Symptomatic ICH occurred in 6 cases. GRASPS scores ranged between 49 and 87, and the ROC area under the curve was 0.73 (95% CI = 0.48-0.98). A score of ?86 had a positive likelihood ratio of 8.8 and correctly classified 87.8% of the population. Using this cut-off, the specificity was 94.3% and the sensitivity was 50.0%.

Conclusions CONCLUSIONS: The GRASPS score may be a useful prediction tool for the risk of sICH in AIS patients receiving iv-tPA within 3 hours of symptom onset. A higher GRASPS score, specifically 86 and higher, predicts the occurrence of sICH; however, the score had a low sensitivity. Our findings underscore the need for prospective validation of the GRASPS score in different clinical settings with diverse study population.

Authors/Disclosures
Archie Ong, MD PRESENTER	No disclosure on file
Lily Lee, PhD	Dr. Lee has nothing to disclose.
Amre Nouh, MD, FAAN (Cleveland Clinic)	Dr. Nouh has stock in Openwater.
	No disclosure on file
Rebbeca Grysiewicz, DO	No disclosure on file
Aslam Khaja, MD (Northwest Neurology)	Dr. Khaja has nothing to disclose.
Neelofer Shafi, MD	Dr. Shafi has nothing to disclose.
Sean D. Ruland, MD (Loyola University Medical Center)	Dr. Ruland has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up to Date. Dr. Ruland has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Law Firms.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Fernando D. Testai, MD, PhD, FAAN (University of Illinois at Chicago)	Dr. Testai has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Testai has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Livingston, Barger, Brandt & Schroeder, L.L.P.. Dr. Testai has received publishing royalties from a publication relating to health care.

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