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Abstract Details

Prediction of Malignant Edema in Anterior Circulation Stroke: Validation of the EDEMA Score and Added Value of Stroke Severity
Cerebrovascular Disease and Interventional Neurology
P2 - Poster Session 2 (5:30 PM-6:30 PM)
3-037

We aimed to externally validate the Enhanced Detection of Edema in Malignant Anterior Circulation Stroke (EDEMA) score for predicting potentially lethal malignant edema (PLME) after stroke in a Chinese cohort and to test whether adding stroke severity to the EDEMA score could improve the predictive performance.

Early prediction of potentially lethal PLME after stroke is useful in selecting patients for aggressive intervention. EDEMA score was recently developed to predict PLME using variables within 24 hours of onset. 

Patients with anterior circulation stroke, cerebral edema, National Institutes of Health Stroke Scale (NIHSS) score ≥ 8 and head computed tomography within 24 hours of onset were enrolled. The outcome of PLME was defined as death with midline shift ≥ 5 mm or decompressive hemicraniectomy. Discrimination was assessed using area under receiver operating characteristic curve (AUC). Calibration was assessed by calibration plot. Decision curve analysis (DCA) was performed to evaluate the clinical usefulness of the score. The added value of stroke severity (admission NIHSS score) was evaluated using AUC, net reclassification improvement, and integrated discrimination improvement.

A total of 399 patients were included in the final analysis. PLME was observed in 79 (18%) patients. Increasing EDEMA score was associated with higher risk of PLME (odds ratio, 1.70; 95% confidence interval [CI], 1.45-1.98). The EDEMA score showed moderate discriminative ability (AUC 0.73; 95% CI 0.68–0.77) and moderate calibration (P=0.294). DCA showed its net benefit across the full range of threshold probabilities. Addition of the admission NIHSS to the EDEMA score significantly increased the model performance. 
The EDEMA score shows an acceptable predictive performance of PLME in a large Chinese cohort. The EDEMA score, when combined with stroke severity, may facilitate prognostication and decision making for most practitioners.
Authors/Disclosures
Yajun Cheng
PRESENTER
No disclosure on file
No disclosure on file
Yanan Wang No disclosure on file
No disclosure on file
Liu Ming No disclosure on file