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Background: Hematoma expansion (HE) occurs in approximately one-third of patients with intracerebral hemorrhage (ICH) and is known to be a strong predictor of neurological deterioration as well as poor functional outcome. This study aims to externally validate three risk prediction models of HE (PREDICT, 9-point, and BRAIN scores) in an Asian population.Methods: A prospective cohort of 123 spontaneous ICH patients admitted to a tertiary hospital (certified stroke center) in Singapore was recruited. Logistic recalibrations were performed to obtain updated calibration slopes and intercepts for all models. The discrimination (c-statistic), calibration (Hosmer-Lemeshow test, le Cessie-van Houwelingen-Copas-Hosmer test, Akaike information criterion), overall performance (Brier score, R2), and clinical usefulness (decision curve analysis) of the risk prediction models were examined.Results: Overall, the recalibrated PREDICT performed best among the three models in our study cohort based on the novel matrix comprising of Akaike information criterion and c-statistic. The PREDICT model had the highest R2 (0.26) and lowest Brier score (0.14). Decision curve analyses showed that recalibrated PREDICT was more clinically useful than 9-point and BRAIN models over the greatest range of threshold probabilities. The two scores (PREDICT and 9-point) which incorporated computed tomography (CT) angiography spot sign outperformed the one without (BRAIN).Conclusions: To our knowledge, this is the first study to validate HE scores, namely PREDICT, 9-Point and BRAIN, in a multi-ethnic Asian ICH patient population. The PREDICT score was the best performing model in our study cohort, based on the performance metrics employed in this study. Our findings also showed support for CT angiography spot sign as a predictor of outcome after ICH. Although the models assessed are sufficient for risk stratification, the discrimination and calibration are at best moderate and could be improved. [ABSTRACT FROM AUTHOR]

Introduction: Intrathecal baclofen (ITB) therapy is a proven, effective treatment for disabling cortical spasticity. We describe the first local series of five patients with acquired brain injury (ABI) who received ITB and were followed up for 63.8 months.Methods: A retrospective review of medical and rehabilitation records of patients who received ITB therapy was carried out. Data studied included baseline demographic and injury variables, implantation data, spasticity and function, ITB dosage over time and complications.Results: From 2006 to 2010, a total of five patients received ITB therapy via implanted pumps about 39.4 months after ABI. Four out of five patients experienced significant reductions in their lower limb spasticity scores and improvements in global function and dependency. One patient had minor adverse events associated with baclofen-related sedation. The mean ITB dose at one year was 182.7 ± 65.6 mcg/day.Conclusion: Our preliminary study showed encouraging long-term outcomes and safety for ITB therapy after ABI-related intractable spasticity. Individual ITB responses over time were variable, with gender differences. The outcomes experienced by our centre were comparable to those in the general ABI population, supporting the efficacy of ITB therapy for chronic disabling spasticity. [ABSTRACT FROM AUTHOR]

Objective Current prognostic models for traumatic brain injury (TBI) are developed from diverse historical data sets. We aimed to construct a prognostication tool for patients with severe TBI, as this group would benefit most from an accurate model. Methods Model development was based on a cohort of 300 patients with severe TBI (Glasgow Coma Scale score ≤8) consecutively admitted to a neurosurgical intensive care unit at the National Neuroscience Institute (NNI), Singapore, between February 2006 and December 2009. We analyzed prospectively collected data of admission characteristics using univariate and multivariate logistic regressions to predict 14-day and 6-month mortality and 6-month unfavorable outcome. Comparison with Corticosteroid Randomization After Significant Head Injury (CRASH) and Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) models was done using Akaike information criterion. Results Two prediction models, NNI Clinical (age, Glasgow Coma Scale score, pupillary reactivity) and NNI+ (NNI Clinical model with addition of obliteration of third ventricle or basal cisterns, presence of subdural hemorrhage, hypoxia, and coagulopathy), were derived from this data set. Both models predicted well across 3 outcome measures with area under the curve values of 0.84–0.91, with adequate calibration. Comparison with CRASH and IMPACT models showed better performance by both derived models with lower Akaike information criterion and higher area under the curve values. Conclusions Two accurate prognostic models, NNI Clinical and NNI+, were developed from our cohort of patients with severe TBI. Both models are specific to severe TBI and could be better alternatives to current available models. External validation is required to assess performance of models in a different setting. [ABSTRACT FROM AUTHOR]

Background: Neurologic disorders impose a heavy burden on healthcare in Singapore. To date, no data on the willingness to pay (WTP) for neurologic treatments has been reported in the local population., Objectives: We aimed to quantify the value of various health domains to neuroscience patients and their caregivers by comparing their WTP for different types of treatments., Methods: A questionnaire using a mixed open-ended and closed-ended contingent valuation method was developed to elicit WTP and self-administered by 112 visitors to a neuroscience outpatient clinic. The WTP for treatments in 3 health domains (advanced restoration of function, life extension, and cosmesis) was evaluated and compared. Subgroup regression analysis was performed to investigate the impact of demographic and socioeconomic factors., Results: Treatment that improved cosmesis had the highest median WTP of Singapore dollar (SGD) 35 000, followed by treatment that provided 1 year of life extension (SGD 20 000) and 1 year of advanced restored function (SGD 10 000; P < .001). Respondents with a university education were willing to pay as much as 2 to 3 times of those without across all health domains., Conclusion: This is the first study to provide data on how different health domains are valued by neuroscience patients and caregivers in our population. Respondents valued treatment that restored or improved their physical appearances the most. These findings could contribute to future policies on the improvement of neuroscience care., (Copyright © 2019 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.)

The use of anticoagulation and antiplatelet agents (ACAP) has steadily increased over recent years. However, the effects of ACAP on traumatic brain injuries (TBI) are not well investigated. The aim of this study was to investigate the effects of pre-injury ACAP use on clinical outcome and mortality in severe TBI. A retrospective case-control study was performed for all patients who presented with severe TBI (GCS < 8) to the National Neuroscience Institute, Singapore, between 2006 and 2009. Patients with pre-injury ACAP use were compared to matched controls. Outcome measures were mortality at 14 days and 6 months, and Glasgow Outcome Score (GOS) at 6 months using a sliding dichotomy approach. Univariate analysis was performed using Chi-square and student's t-test and logistic regression was used to model the effect of ACAP on mortality rate. Forty-five patients with pre-injury use of ACAP were compared with matched controls. The mortality at 14 days (OR = 0.5, 95% CI 0.2-1.4) and 6 months (OR = 0.7, 95% CI 0.2-1.9) were not significantly different between the 2 groups. Using the sliding dichotomy approach, there was no difference in the odds for unfavorable functional outcomes at 6 months (OR = 1.2, 95% CI 0.4-3.7). In this case-control study, the use of ACAP did not have a significant effect on mortality and adverse outcomes in patients with severe TBI. This would suggest that in severe TBI, ACAP use may not contribute significantly to the overall prognosis., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: Numerous scores have been developed for prognostication of outcomes in intracerebral hemorrhage (ICH). Prediction models must be validated internally and externally before they are considered widely applicable. We aim to independently externally validate and compare 3 prediction models (ICH score, ICH grading scale [ICH-GS], and simplified ICH [sICH]) in our population, which has not been previously done., Methods: We reviewed 1338 patients with spontaneous ICH consecutively admitted to the National Neuroscience Institute, Singapore, between January 2009 and November 2013. We analyzed prospectively collected data of admission characteristics (clinical, neuroimaging, and laboratory findings). All 3 scores prognosticated 30-day mortality. Validation was based on calibration, goodness-of-fit tests, and discrimination (area under receiver operating characteristic curve [AUC]). Akaike information criterion (AIC) and decision curve analysis (DCA) were used to directly compare the scores., Results: All 3 models showed good calibration and both the Hosmer-Lemeshow and the le Cessie-van Houwelingen-Copas goodness-of-fit test showed P values >0.05. AUCs ranged from 0.86 to 0.90, indicating good discriminative ability, with the ICH-GS performing the best with the highest AUC, lowest AIC (849), and overall highest net benefit in the DCA., Conclusions: This study successfully independently validates the ICH score, ICH-GS, and sICH score in a large patient cohort with spontaneous ICH, which has not been previously done in this non-Western population. We recommend the use of the ICH-GS as a prognostication tool in our patients instead of the widely used ICH score., (Copyright © 2017 Elsevier Inc. All rights reserved.)