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SMASH-U classification: a tool for aetiology-oriented management of patients with acute haemorrhagic stroke

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Abstract

Intracerebral haemorrhage (ICH) is responsible for disproportionately high morbidity and mortality rates. The most used ICH classification system is based on the anatomical site. We used SMASH-U, an aetiological based classification system for ICH by predefined criteria: structural vascular lesions (S), medication (M), amyloid angiopathy (A), systemic disease (S), hypertension (H), or undetermined (U). We aimed to correlate SMASH-U classification of our patients to the intra-hospital mortality rates. We performed a single centre retrospective study at the Santa Maria Della Misericordia Hospital, Perugia (Italy) including consecutive patients between January 2009 and July 2017 assigned with 431 ICD-9 (International Classification of Diseases-9). We classified the included patients using SMASH-U criteria, and we analysed the association between SMASH-U aetiology and ICH risk factors to the outcome defined as intra-hospital mortality, using multivariable logistic regression analysis. The higher intra-hospital mortality rate was detected in the systemic disease (36.1%), medication (31.5%), and undetermined (29.4%) groups. At multivariable analysis, medication and systemic disease groups resulted associated with the outcome (odds ratio 3.47; 95% CI 1.15–10.46; P = 0.02 and 3.64; 95% CI 1.47–9.01; P = 0.005, respectively). Furthermore, age and high NIHSS at admission resulted significantly associated with intra-hospital mortality (odds ratio 1.01; 95% CI 1–1.03; P = 0.04 and 1.12; 95% CI 1.03–1.22; P = 0.008, respectively). In our retrospective study, the aetiology-oriented classification system SMASH-U showed to be potentially predictive of intra-hospital mortality of acute haemorrhagic stroke patients and it may support clinicians in the acute ICH management.

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Authors and Affiliations

  1. Stroke Unit and Division of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Piazzale Menghini 1, 06129, Perugia, Italy

    Maria Giulia Mosconi, Maurizio Paciaroni, Giancarlo Agnelli, Martino Marzano, Andrea Alberti, Michele Venti, Monica Acciarresi & Valeria Caso

  2. “Ufficio Controllo di Gestione e Sistema Informativo”, Santa Maria della Misericordia Hospital, Piazzale Menghini 1, Perugia, 06129, Italy

    Fabrizio Ruffini

Authors
  1. Maria Giulia Mosconi
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  2. Maurizio Paciaroni
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  3. Giancarlo Agnelli
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  4. Martino Marzano
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  5. Andrea Alberti
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  9. Valeria Caso
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Correspondence to Maria Giulia Mosconi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards

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Mosconi, M.G., Paciaroni, M., Agnelli, G. et al. SMASH-U classification: a tool for aetiology-oriented management of patients with acute haemorrhagic stroke. Intern Emerg Med 16, 109–114 (2021). https://doi.org/10.1007/s11739-020-02330-2

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