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Abstract：
BACKGROUND: The objective of this document is to provide recommendations on the formal reliability of major clinical predictors often associated with intracerebral hemorrhage (ICH) neuroprognostication.
METHODS: A narrative systematic review was completed using the Grading of Recommendations Assessment, Development, and Evaluation methodology and the Population, Intervention, Comparator, Outcome, Timing, Setting questions. Predictors, which included both individual clinical variables and prediction models, were selected based on clinical relevance and attention in the literature. Following construction of the evidence profile and summary of findings, recommendations were based on Grading of Recommendations Assessment, Development, and Evaluation criteria. Good practice statements addressed essential principles of neuroprognostication that could not be framed in the Population, Intervention, Comparator, Outcome, Timing, Setting format.
RESULTS: Six candidate clinical variables and two clinical grading scales (the original ICH score and maximally treated ICH score) were selected for recommendation creation. A total of 347 articles out of 10,751 articles screened met our eligibility criteria. Consensus statements of good practice included deferring neuroprognostication-aside from the most clinically devastated patients-for at least the first 48-72 h of intensive care unit admission; understanding what outcomes would have been most valued by the patient; and counseling of patients and surrogates whose ultimate neurological recovery may occur over a variable period of time. Although many clinical variables and grading scales are associated with ICH poor outcome, no clinical variable alone or sole clinical grading scale was suggested by the panel as currently being reliable by itself for use in counseling patients with ICH and their surrogates, regarding functional outcome at 3 months and beyond or 30-day mortality.
CONCLUSIONS: These guidelines provide recommendations on the formal reliability of predictors of poor outcome in the context of counseling patients with ICH and surrogates and suggest broad principles of neuroprognostication. Clinicians formulating their judgments of prognosis for patients with ICH should avoid anchoring bias based solely on any one clinical variable or published clinical grading scale.
METHODS: A narrative systematic review was completed using the Grading of Recommendations Assessment, Development, and Evaluation methodology and the Population, Intervention, Comparator, Outcome, Timing, Setting questions. Predictors, which included both individual clinical variables and prediction models, were selected based on clinical relevance and attention in the literature. Following construction of the evidence profile and summary of findings, recommendations were based on Grading of Recommendations Assessment, Development, and Evaluation criteria. Good practice statements addressed essential principles of neuroprognostication that could not be framed in the Population, Intervention, Comparator, Outcome, Timing, Setting format.
RESULTS: Six candidate clinical variables and two clinical grading scales (the original ICH score and maximally treated ICH score) were selected for recommendation creation. A total of 347 articles out of 10,751 articles screened met our eligibility criteria. Consensus statements of good practice included deferring neuroprognostication-aside from the most clinically devastated patients-for at least the first 48-72 h of intensive care unit admission; understanding what outcomes would have been most valued by the patient; and counseling of patients and surrogates whose ultimate neurological recovery may occur over a variable period of time. Although many clinical variables and grading scales are associated with ICH poor outcome, no clinical variable alone or sole clinical grading scale was suggested by the panel as currently being reliable by itself for use in counseling patients with ICH and their surrogates, regarding functional outcome at 3 months and beyond or 30-day mortality.
CONCLUSIONS: These guidelines provide recommendations on the formal reliability of predictors of poor outcome in the context of counseling patients with ICH and surrogates and suggest broad principles of neuroprognostication. Clinicians formulating their judgments of prognosis for patients with ICH should avoid anchoring bias based solely on any one clinical variable or published clinical grading scale.
摘要：
背景：本文件的目的是就通常与脑出血（ICH）神经预后相关的主要临床预测因子的形式可靠性提供建议。
方法：使用建议评估等级完成了叙述性系统综述，发展,以及评估方法和人口，干预,比较器,结果,定时,设置问题。预测器,其中包括个体临床变量和预测模型，根据文献中的临床相关性和注意力进行选择。在构建证据概况和调查结果总结之后，建议基于建议评估的分级，发展,和评价标准。良好做法声明涉及无法在人口中建立的神经预后的基本原则，干预,比较器,结果,定时,设置格式。
结果：选择六个候选临床变量和两个临床分级量表（原始ICH评分和最大治疗ICH评分）作为推荐创建。在筛选的10751篇文章中，共有347篇文章符合我们的资格标准。良好实践的共识声明包括至少在重症监护病房入院的前48-72小时内推迟神经预后-除了临床上最严重的患者之外；了解患者最重视的结果；以及对患者和代孕者的咨询，其最终的神经系统恢复可能在可变的时间内发生。尽管许多临床变量和分级量表与ICH不良结局相关，没有单独的临床变量或唯一的临床分级量表被小组认为是目前可靠的使用在咨询ICH患者和他们的代理人。关于3个月及以上或30天死亡率的功能结局。
结论：这些指南在为ICH患者和代孕患者提供咨询的背景下，对不良预后预测因子的正式可靠性提供了建议，并提出了神经预后的广泛原则。制定ICH患者预后判断的临床医生应避免仅基于任何一个临床变量或已发布的临床分级量表的锚定偏倚。
方法：使用建议评估等级完成了叙述性系统综述，发展,以及评估方法和人口，干预,比较器,结果,定时,设置问题。预测器,其中包括个体临床变量和预测模型，根据文献中的临床相关性和注意力进行选择。在构建证据概况和调查结果总结之后，建议基于建议评估的分级，发展,和评价标准。良好做法声明涉及无法在人口中建立的神经预后的基本原则，干预,比较器,结果,定时,设置格式。
结果：选择六个候选临床变量和两个临床分级量表（原始ICH评分和最大治疗ICH评分）作为推荐创建。在筛选的10751篇文章中，共有347篇文章符合我们的资格标准。良好实践的共识声明包括至少在重症监护病房入院的前48-72小时内推迟神经预后-除了临床上最严重的患者之外；了解患者最重视的结果；以及对患者和代孕者的咨询，其最终的神经系统恢复可能在可变的时间内发生。尽管许多临床变量和分级量表与ICH不良结局相关，没有单独的临床变量或唯一的临床分级量表被小组认为是目前可靠的使用在咨询ICH患者和他们的代理人。关于3个月及以上或30天死亡率的功能结局。
结论：这些指南在为ICH患者和代孕患者提供咨询的背景下，对不良预后预测因子的正式可靠性提供了建议，并提出了神经预后的广泛原则。制定ICH患者预后判断的临床医生应避免仅基于任何一个临床变量或已发布的临床分级量表的锚定偏倚。
