Clinical Grading Score Case Review

Clinical grading scales play an important role in the evaluation and management of adult patients with acute neurological disorders, especially in hemorrhagic stroke.8, 9 In pediatric ICH, we demonstrated that a specifically dedicated to childhood ICH Score, the NICH Score, may be used as a clinical tool to predict 12-months outcome. A NICH Score of ≥5, ≥6 and ≥7/13 is sensitive for predicting, respectively, moderate disability or worse, severe disability or worse and vegetative state or death at 12-months. A significant strength of this study was the sample size, though this study represents the largest prospective pediatric ICH cohort to date, allowing performing multivariable analyses on the components of the Score. By sequentially eliminating
All are easy to assess and are dichotomous variables. In line with adult studies,9 the association of poor outcome and IVH was demonstrated in our study. This finding contrasts with previous pediatric studies. In Beslow et al.,6 IVH was not statistically associated with unfavorable outcome. However, due to the small sample size (22 children), it is possible that the added negative effect of IVH was too small to be
While prognostication is undoubtedly important to assess treatment benefits and risks and to provide children and families with information regarding severity of illness, attempts to precisely prognosticate outcome may lead to inappropriate “self-fulfilling prophecies”. The NICH Score is most appropriately used to provide a framework for clinical decision-making and to provide reliable criteria for assessing efficacy of new treatments. Thus, a scale such as the NICH Score could be used as part of risk stratification for ICH treatment studies, but not as a precise predictor of outcome. However, before this should be considered, validation of the NICH Score in an independent data set, especially using functional outcome at a meaningful time point, should be undertaken. Additionally, factors not represented in the NICH Score, such as time of onset or age, will always play an important role in selection of patients for clinical treatment or clinical research studies. Despite these issues, improved standardization of clinical assessment with the use of the NICH Score is likely to provide more consistency in clinical care and clinical research for pediatric ICH, just as similar assessment scales have provided consistency in adult ICH. This in turn could provide an important step in developing new treatments for pediatric ICH, a disease with no current treatment of proven