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10-02-2013 | Surgery | Article

Modified measure quickly and effectively gauges intraventricular hemorrhage


Free abstract

medwireNews: Researchers have modified the Graeb score to produce a reliable, simple, quick, and clinically meaningful approximation of intraventricular hemorrhage (IVH) volume.

The modified Graeb Scale (mGS) was applied in a Stroke study as a semiquantitative score to measure IVH volume, demonstrating good inter- and intrareader reliability, a close relation to IVH volume, and a predictive capacity for outcome in line with actual IVH volume.

Joint first authors Timothy Morgan (Johns Hopkins Medical Institutions, Baltimore, Maryland, USA) and Jesse Dawson (University of Glasgow, UK), along with their colleagues, designed the mGS to provide greater flexibility than the original Graeb score (oGS) by detecting IVH in differing ventricular compartments as well as providing a more accurate measure of change in IVH volumes over time.

Use of mGS in a wider population of IVH patients produced a 12% increased odds for poor outcome for each 1-unit increase in mGS, independent of other measures such as intracerebral hemorrhage volume and baseline stroke severity.

"Not only do our data show that the mGS is a useful means of quantifying IVH extent," write the authors, "it highlights the crucial importance of quantifying IVH in both clinical research and clinical practice."

The researchers validated the mGS by first comparing the relationship between the mGS, the oGS, volumetrically measured IVH, and outcome using data from the Clot Lysis: Evaluating Accelerated Resolution of Hemorrhage with rtPA B (CLEAR B) trial, which included 360 brain scans from 36 patients.

Both the oGS and mGS were highly correlated with IVH volume, although the former relationship appeared more variable than the latter. Additionally, baseline mGS and IVH volume had similar accuracy for predicting 180-day functional outcome.

Subsequently, the authors explored the relationship between mGS and 90-day functional outcome in a large sample of patients with IVH by using data from the Virtual International Stroke Trials Archive (VISTA), which included 399 participants with IVH. In a multivariable model, mGS predicted poor outcome when variables such as age and ICH volume were included.

The authors point out the advantage of the mGS's simplicity when assessing IVH volume since it takes only a few minutes to administer and requires just a computed tomography (CT) scan - as opposed to sophisticated software - to assign a score. Its ease of use, they add, can accommodate highly trained neuroradiologists as well as less specialist CT readers.

"[The mGS] is reliable and valid, and more closely related to change in IVH volume and outcome than the oGS," the authors conclude. "[It] could readily be used to assess outcomes in clinical trials of [spontaneous intracerebral hemorrhage] and IVH and to monitor progress of thrombolytic therapy for IVH."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Peter Sergo, medwireNews Reporter