TURN: A Simple Predictor of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis

David Asuzu, Karin Nyström, Hardik Amin, Joseph Schindler, Charles Wira, David Greer, Nai Fang Chi, Janet Halliday, Kevin N. Sheth*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: IV Thrombolysis (rt-PA) for ischemic stroke treatment carries a substantial risk for symptomatic intracerebral hemorrhage (sICH). Our purpose was to develop a computationally simple and accurate sICH predictor Methods : Our derivation dataset consisted of 210 ischemic stroke patients receiving IV rt-PA from January 2009 until July 2013 at Yale-New Haven Hospital. Our validation dataset included 303 patients who received IV rt-PA during the NINDS rt-PA trial. Independent sICH predictors were identified by logistic regression and combined to form the TURN score. Predictive ability and goodness of fit were quantified by odds ratios (OR) and areas under the receiver operating characteristic curve (AUROC). Results: 3 out of 17 clinical parameters were identified as independent predictors of sICH: prestroke mRS score (OR 1.54, P = 0.02), baseline NIHSS score (OR 1.13, P = 0.002), and platelet count (OR 0.99, P = 0.04). We combined these three parameters to form the TURNP score. For added simplicity, prestroke mRS score and baseline NIHSS score alone were also combined to form the TURN score, and predicted sICH without a significant drop in OR or AUROC. Conclusions: We developed a new score for predicting sICH after IV thrombolysis. Our score is simple and with acceptable accuracy, making it ideal for use in the hyperacute stroke setting.

Original languageEnglish
Pages (from-to)166-171
Number of pages6
JournalNeurocritical Care
Issue number2
StatePublished - 7 Oct 2015


  • Adverse outcomes
  • Intracerebral hemorrhage
  • Ischemic stroke
  • IV Thrombolysis
  • Predictive scores


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