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Open Access Research article

Oxfordshire community stroke project classification improves prediction of post-thrombolysis symptomatic intracerebral hemorrhage

Sheng-Feng Sung12, Solomon Chih-Cheng Chen3, Huey-Juan Lin45, Chih-Hung Chen6, Mei-Chiun Tseng7, Chi-Shun Wu1, Yung-Chu Hsu1, Ling-Chien Hung1 and Yu-Wei Chen89*

Author Affiliations

1 Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan

2 Min-Hwei College of Health Care Management, Tainan, Taiwan

3 Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan

4 Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan

5 Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

6 Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan

7 Landseed Hospital, Tao-Yuan County, Taiwan

8 Department of Neurology, Landseed Hospital, Tao-Yuan County, Taiwan

9 Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan

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BMC Neurology 2014, 14:39  doi:10.1186/1471-2377-14-39

Published: 1 March 2014

Abstract

Background

The Oxfordshire Community Stroke Project (OCSP) classification is a simple stroke classification system with value in predicting clinical outcomes. We investigated whether and how the addition of OCSP classification to the Safe Implementation of Thrombolysis in Stroke (SITS) symptomatic intracerebral hemorrhage (SICH) risk score improved the predictive performance.

Methods

We constructed an extended risk score by adding an OCSP component, which assigns 3 points for total anterior circulation infarcts, 0 point for partial anterior circulation infarcts or lacunar infarcts. Patients with posterior circulation infarcts were assigned an extended risk score of zero. We analyzed prospectively collected data from 4 hospitals to compare the predictive performance between the original and the extended scores, using area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI).

Results

In a total of 548 patients, the rates of SICH were 7.3% per the National Institute of Neurological Diseases and Stroke (NINDS) definition, 5.3% per the European-Australasian Cooperative Acute Stroke Study (ECASS) II, and 3.5% per the SITS-Monitoring Study (SITS-MOST). Both scores effectively predicted SICH across all three definitions. The extended score had a higher AUC for SICH per NINDS (0.704 versus 0.624, P = 0.015) and per ECASS II (0.703 versus 0.612, P = 0.016) compared with the SITS SICH risk score. NRI for the extended risk score was 22.3% (P = 0.011) for SICH per NINDS, 21.2% (P = 0.018) per ECASS II, and 24.5% (P = 0.024) per SITS-MOST.

Conclusions

Incorporation of the OCSP classification into the SITS SICH risk score improves risk prediction for post-thrombolysis SICH.