Validation of TURN, a simple predictor of symptomatic intracerebral hemorrhage after IV thrombolysis

• Stroke remains a leading cause of severe disability and death in the US.
• TURN score predicts sICH after IV thrombolysis for ischemic stroke.
• TURN is computationally simple compared to existing scores.
• TURN predicts sICH well compared to existing scores.
• We derived a clinically meaningful cutoff for sICH prediction.

ObjectiveWe recently described TURN (Thrombolysis risk Using mRS and NIHSS), a computationally simple tool for predicting symptomatic intracerebral hemorrhage (sICH) after IV thrombolysis (rt-PA). Our objective was to compare TURN to existing scores for predicting sICH.MethodsOur internal dataset consisted of 210 ischemic stroke patients receiving IV rt-PA from January 2009 until July 2013 at Yale New Haven Hospital. Our external dataset included 303 patients who received IV rt-PA during the NINDS rt-PA trial. Predictive ability and goodness of fit were quantified by odds ratios (OR) and areas under the receiver operating characteristic curve (AUROC), and compared using unequal variance two-sample t-tests.ResultsTURN predicted sICH with a higher OR than ASTRAL in the internal dataset (2.72 versus 1.10, P = 0.05). We found no other significant differences in OR or AUROC between TURN and other scores in both datasets.ConclusionDespite its computational simplicity, TURN predicts sICH with accuracy comparable to existing scores.