Thrombolysis risk prediction: applying the SITS-SICH and SEDAN scores in South African patients

At present, the only specific medical treatment for acute ischaemic stroke isintravenous administration of recombinant tissue plasminogen activatorwithin 4.5 hours of stroke onset. In the last year, two scores for riskstratification of intracranial haemorrhage have been derived frommulticentric European trial groups, the Safe Implementation of Treatment inStroke – Symptomatic IntraCerebral Haemorrhage risk score (SITS-SICH) andthe SEDAN score. The aim of this study was to pilot their use in a cohort ofpatients treated at a South African tertiary hospital.Prospectively collected data were used from a cohort of 41 patients whounderwent thrombolysis at Groote Schuur Hospital from 2000 to 2012.Computerised tomography brain imaging was available for review in 23 ofthese cases. The SITS-SICH and SEDAN scores were then applied and riskprediction was compared with outcomes.Two patients suffered symptomatic intracranial haemorrhage (SICH),representing 4.9% (95% CI: 0–11.5%) of the cohort. This was comparable tothe SICH rate in both the SITS-SICH (5.1%) and SEDAN (6.5%) cohorts. Patientscores in the Groote Schuur Hospital cohort appeared similar to those of thevalidation cohorts of both SITS-SICH and SEDAN.With increasing use of thrombolysis in a resource-constrained setting, thesescores represent a potentially useful tool in patient selection of thosemost likely to benefit from intravenous thrombolysis, reducing risk for SICHand with the added benefit of curtailing cost.