Background: Hemorrhagic transformation (HT) after rtPA in acute ischemic stroke is a known complication of thrombolytic therapy. Several grading scales have been introduced in clinical practice, aiming to quantify the risk of HT before rtPA is administered. The goals of this study are to evaluate the performance of existing grading scales in a rural population of the Midwest and improve the existing models.
Methods: This is a retrospective study of stroke patients treated with thrombolytics at Southern Illinois Healthcare from July 2017 to August 2024. Demographics, clinical presentations, laboratory values, neuroimaging, and stroke metrics were collected. HT found on neuroimaging within 24 h after rtPA was reviewed. mRS at 30 days was noted. The cohort was divided in two groups: HT and no-HT. The two groups were compared by univariate analyses. SEDAN, HAT, MSS, and THRIVE scores were calculated, and multivariable logistic regression analysis was run for each model. Area under the receiver operating characteristic curve (AUC) with its 95 % confidence interval was calculated for each grading scale. P value was set at 0.05.
Results: Out of 279 patients included in this study, HT occurred in 8.6 % of patients (n = 24), whereas 91.4 % (n = 255) had no-HT. The two groups were similar in baseline characteristics and stroke severity. HT group had significantly worse mRS 0-2 at 30 days (42 % vs. 69 %, p < 0.05). SEDAN score demonstrated the highest accuracy in predicting HT after rtPA (AUC = 0.65, 95 % CI:0.56-0.75). Adding 1 point for smoking to the score, SEDAN-S, improved the accuracy of the model (AUC = 0.67, 95 % CI:0.57-0.77).
Conclusions: Existing predictive scales of HT after rtPA underperform in our rural population. Among those, SEDAN score is the most accurate predictor. Adding smoking status to the score improves its accuracy. Further larger studies in similar rural populations should be performed to confirm our results.
Keywords: Acute ischemic stroke; Grading scales; Hemorrhagic transformation; Rural setting; Tpa.
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