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Original Article

Neurology
Clinical variable-based decision-support model for rapid differentiation of hemorrhagic and ischemic stroke at emergency department presentation in South Korea: Jae-Woo Kim, Jin-Heon Jeong, Moon-Ku Han, Sang-Hoon Han, Ka Hyun Kim, Seung Park, Dong-Ick Shin, Kyu Sun Yum; Acute Crit Care. 2026;41(2):364-377. Published online February 27, 2026; DOI: https://doi.org/10.4266/acc.004925

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Abstract PDF Supplementary Material: Background
Prompt differentiation between ischemic stroke (IS) and hemorrhagic stroke (HS) is critical because their treatment strategies fundamentally differ. While neuroimaging is essential, clinical decision-making often begins before imaging is completed, and conventional clinical scores have shown inconsistent performance. The objective of this study was therefore to develop and externally validate a machine-learning model that supports HS vs. IS subtype suspicion at emergency department (ED) presentation using only clinical variables. Methods: We conducted a retrospective multicenter cohort study of 2,998 adult patients with a final diagnosis of acute IS or HS treated at three comprehensive stroke centers (July 2020–January 2024). Patients from hospitals A and B comprised the development/internal validation cohort (n=2,418), while patients from hospital C served as an independent external validation cohort (n=580). An extreme gradient boosting (XGBoost) algorithm was trained using four-fold cross-validation, and feature contributions were assessed using Shapley additive explanation (SHAP) values. Results: Internal validation showed an area under the receiver operating characteristic curve (AUROC) of 0.937 (95% CI, 0.922–0.950) with a sensitivity 0.828, specificity of 0.932, and accuracy of 0.905. Independent external validation yielded an AUROC of 0.841 (95% CI, 0.792–0.883) with a sensitivity 0.758, specificity of 0.789, and accuracy of 0.783. SHAP analysis identified headache and higher National Institutes of Health Stroke Scale item 1a (level of consciousness) as factors increasing the model output toward HS, whereas atrial fibrillation shifted predictions toward IS. Conclusions: A clinical variable-only model can support early HS vs. IS subtype suspicion at ED presentation among patients managed in an acute-stroke pathway without requiring laboratory tests. Performance decreased on independent external validation, suggesting potential site-related differences and the need for prospective evaluation and calibration. Stroke mimics were not included and should be addressed in future studies.

Editorial

Neurology
We need a comprehensive intensive care unit management strategy for older patients: Dong-Ick Shin; Acute Crit Care. 2022;37(3):468-469. Published online August 29, 2022; DOI: https://doi.org/10.4266/acc.2022.01025

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1 Web of Science
2 Crossref

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Citations

Citations to this article as recorded by

The impact of instrumented lumbar fusion surgery on psychiatric problems in elderly patients with degenerative spinal stenosis: The observational study
Won Rak Choi, Sang Min Ahn, Seok Hyeon Kim, Keong Yoon Kim, Hee Jung Son, Chang-Nam Kang
Medicine.2024; 103(26): e38719. CrossRef
A comprehensive intensive care for senior citizens: the need for public health policy
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Acute and Critical Care.2022; 37(4): 690. CrossRef

Review Article

Neurology
Transient splenial lesions of the corpus callosum and infectious diseases: Kyu Sun Yum, Dong-Ick Shin; Acute Crit Care. 2022;37(3):269-275. Published online August 17, 2022; DOI: https://doi.org/10.4266/acc.2022.00864

20,971 View
447 Download
9 Web of Science
14 Crossref

Abstract PDF

Transient splenial lesion of the corpus callosum can be observed in various diseases such as cancer, drug use, metabolic disorders, and cerebrovascular disorders, as well as in patients with infectious diseases. During the coronavirus disease 2019 (COVID-19) pandemic, there were increasing reports of these lesions being detected on brain imaging tests performed in patients with neurological symptoms. On brain magnetic resonance imaging, findings suggestive of cytotoxic edema are observed in the splenium; these are known to disappear with improvement of clinical symptoms. Cytokinopathy caused by infection increases the permeability of the blood–brain barrier and activates the glial cells of the brain to induce cytotoxic edema. Most patients have a good prognosis. The causes, mechanism, diagnosis, treatment and prognosis of transient splenial lesions of the corpus callosum will be summarized in this review.

Citations

Citations to this article as recorded by

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