SEDAN_Score_for_Post-tPA_Hemorrhage_guideline v.1
SEDAN Score for Post-tPA Hemorrhage predicts risk of Symptomatic Intracerebral Hemorrhage (sICH) after tPA.
To predict the risk of Symptomatic Intracerebral Hemorrhage (sICH) after tPA.
Use to estimate the risk of tPA to patients and their family members. SEDAN Score is weighing the risk of benefit and risk of harm in minor or severe strokes. Applies to patients receiving tPA within 4.5 hours. Variables and points: - Blood sugar: <144 mg/dL (8 mmol/L)=0, 145-216 mg/dL (8.1–12.0 mmol/L)=1, >216 mg/dL (12.0 mmol/L) - Early infarct signs on initial CT: No=0, Yes=1 -Hyperdense cerebral artery sign on initial CT: No=0, Yes=1 - Age > 75 years: No=0, Yes=1 -NIH Stroke Scale (NIHSS) ≥ 10: No=0, Yes=1 SEDAN score formula: Addition of assigned points Sugar (glucose) level on admission: <= 8 mmol/l (<=144 mg/dl) =0 point , 8.1-12 mmol/l (145-216 mg/dl)= 1 point, >12 mmol/l (>216 mg/dl)=2 points Early infarct signs on admission CT head scan: No= 0, Yes 1 Dense or hyperdense cerebral artery sign on admission CT: No=0, Yes=1 Age: <=75=0, >75=1 NIHSS on admission: 0-9 points=0, >=10 points=1. Score interpretation: SEDAN score and Risk of Symptomatic ICH: 0=1.6%, 1= 3.3%, 2=5.4%, 3=8.8%, 4=12.3%, 5=16.9% Points to Consider: - Patients in this score did not receive endovascular therapy. - sICH increases mortality dramatically. - tPA risks and benefits should be very clearly discussed and documented with patients and family members. The ECASS-II definition of sICH was used: An intracranial hemorrhage was defined as symptomatic if the patient had clinical deterioration causing an increase in the NIHSS score of more than or equal to 4 points and if the hemorrhage was likely to be the cause of the clinical deterioration. However, in case of doubt regarding whether edema or hemorrhage was the leading pathology, an association of the hemorrhage with the deterioration was assumed.
Not to use for patients who are receiving endovascular treatment.
1. Strbian D, Engelter S, Michel P, Meretoja A, Sekoranja L, Ahlhelm FJ, Mustanoja S, Kuzmanovic I, Sairanen T, Forss N, Cordier M, Lyrer P, Kaste M, Tatlisumak T.Symptomatic intracranial hemorrhage after stroke thrombolysis: the SEDAN score. Ann Neurol. 2012 May;71(5):634-41. doi: 10.1002/ana.23546. 2. Mazya MV, Bovi P, Castillo J, Jatuzis D, Kobayashi A, Wahlgren N, Ahmed N. External validation of the SEDAN score for prediction of intracerebral hemorrhage in stroke thrombolysis. Stroke. 2013 Jun;44(6):1595-600. doi: 10.1161/STROKEAHA.113.000794. Epub 2013 Apr 30. 3. Van Hooff RJ, et al. Validation assessment of risk tools to predict outcome after thrombolytic therapy for acute ischemic stroke.Clin Neurol Neurosurg. 2014 Oct;125:189-93. doi: 10.1016/j.clineuro.2014.08.011. Epub 2014 Aug 15.
OBSERVATION.basic_demographic.v1, OBSERVATION.sedan_score_for_post_tpa_hemorrhage.v0
