For healthcare professionals
SEDAN Score for Hemorrhage Risk After IV Thrombolysis
The SEDAN score adds points for five findings available before intravenous thrombolysis for acute ischemic stroke: blood sugar, early infarct signs and a dense cerebral artery sign on the admission CT, age, and stroke severity on the NIH Stroke Scale (NIHSS). The total runs from 0 to 6, and it was built to estimate the risk of symptomatic intracranial hemorrhage after thrombolysis. This tool is written for clinicians. It is not a self-check and not a diagnosis.
The five items
Levels and points as printed by von Klemperer and colleagues (von Klemperer 2014). The short notes are our own. Nothing you enter leaves this page.
What you will see
The SEDAN score from 0 to 6 and the points from each item.
Educational only, not medical advice. A score supports clinical judgment; it does not decide treatment on its own.
Source
Strbian D et al., Ann Neurol 2012 (the original score, cited only). Levels and points as printed in von Klemperer A et al., Cardiovasc J Afr 2014 (CC BY), with the same points also printed in Pan Y et al., Brain Behav 2018 (CC BY 4.0).
Validated in
Derived from a multicenter European cohort; the score was externally validated in a cohort of 828 patients (von Klemperer 2014). For use in adults with acute ischemic stroke treated with IV thrombolysis.
Limits
For clinicians, not a diagnosis. Built for patients given IV thrombolysis; it does not decide who should get thrombolysis on its own. The risk for each single score is not shown here; see the original paper. Reading early infarct signs and a dense artery sign on CT needs experience. Use it with, not instead of, clinical judgment.
How the score works
The SEDAN score is named for its items: blood sugar (glucose) on admission, early infarct signs and (hyper)dense cerebral artery sign on the admission CT scan, age, and NIHSS on admission (Pan 2018). It assigns 1 point for baseline glucose 8.1 to 12.0 mmol/L, 2 points for glucose over 12.0 mmol/L, 1 point for early infarct signs, 1 point for a (hyper)dense cerebral artery sign, 1 point for age over 75 years and 1 point for an NIHSS score of 10 or more at admission (Pan 2018). The levels below are set out by von Klemperer and colleagues (von Klemperer 2014). The score was first described by Strbian and colleagues (Strbian 2012).
| Item | Level | Points |
|---|---|---|
| Blood sugar (glucose) on admission | 8 mmol/L or less | 0 |
| 8.1 to 12 mmol/L | 1 | |
| Over 12 mmol/L | 2 | |
| Signs of early infarction on admission CT | No | 0 |
| Yes | 1 | |
| Dense middle cerebral artery sign on admission CT | No | 0 |
| Yes | 1 | |
| Age | 75 years or under | 0 |
| Over 75 years | 1 | |
| NIHSS score on admission | 0 to 9 | 0 |
| 10 or more | 1 |
In that table, signs of early infarction include hypo-attenuation of the middle cerebral artery territory (less than one third), obscuration of the lentiform nucleus, cortical sulcal effacement, focal hypo-attenuation and loss of the insular ribbon (von Klemperer 2014).
What the score predicts
The SEDAN score estimates the risk of symptomatic intracranial hemorrhage after thrombolysis, and the risk rises with the score (von Klemperer 2014). The original paper reports the risk for each score (Strbian 2012). We do not show those figures, because we could not find them printed consistently in two open sources.
How well it performed
In the TIMS-China registry, the SEDAN score had an AUC of 0.61 (95% CI 0.55 to 0.68) for symptomatic intracranial hemorrhage at 3 months (Pan 2018). In a dataset of 1,565 patients with acute ischemic stroke, its AUC for hemorrhagic transformation was 0.70 (0.66 to 0.74) in patients not treated with reperfusion therapy and 0.71 (0.67 to 0.76) in those treated (de Andrade 2022). Results from these cohorts may not carry over to other settings.
Related calculators
For a 0 to 10 outcome score after IV thrombolysis, see the DRAGON score. For a 0 to 9 outcome score from age, NIHSS and three chronic diseases, see the THRIVE score. To score stroke severity, see the NIH Stroke Scale calculator. For a quick age plus NIHSS index, see the SPAN-100 index. Other bedside scores are listed under For healthcare professionals.
Sources
- Strbian D, Engelter S, Michel P, Meretoja A, Sekoranja L, Ahlhelm FJ, et al. Symptomatic intracranial hemorrhage after stroke thrombolysis: the SEDAN score. Ann Neurol. 2012;71(5):634-641. doi:10.1002/ana.23546. PMID 22522478. Original score (cited only). doi.org/10.1002/ana.23546
- von Klemperer A, Bateman K, Bryer A, Owen J. Thrombolysis risk prediction: applying the SITS-SICH and SEDAN scores in South African patients. Cardiovasc J Afr. 2014;25(5):224-227. doi:10.5830/CVJA-2014-043. PMID 25629538. Open access (CC BY). Table 2: SEDAN score items, levels and points (total 6); text: the SEDAN score was externally validated in a cohort of 828 patients; pilot cohort of 41 patients at Groote Schuur Hospital, 2000 to 2012. pmc.ncbi.nlm.nih.gov/articles/PMC4241589/
- Pan Y, Peng Y, Chen W, Wang Y, Lin Y, He Y, Wang N, Wang Y. THRIVE-c score predicts clinical outcomes in Chinese patients after thrombolysis. Brain Behav. 2018;8(2):e00927. doi:10.1002/brb3.927. PMID 29484275. Open access (CC BY 4.0). Methods: SEDAN points; Table 2: AUC for symptomatic intracranial hemorrhage at 3 months, SEDAN 0.61 (0.55-0.68), TIMS-China registry. pmc.ncbi.nlm.nih.gov/articles/PMC5822588/
- de Andrade JBC, Mohr JP, Ahmad M, Lima FO, Barros LCM, Silva GS, et al. Accuracy of predictive scores of hemorrhagic transformation in patients with acute ischemic stroke. Arq Neuropsiquiatr. 2022;80(5):455-461. doi:10.1590/0004-282X-ANP-2021-0091. PMID 35293556. Open access (CC BY 4.0). Table 1: SEDAN variables with glucose 145-216 and >216 mg/dL; Table 3: local dataset (n=1,565), SEDAN AUC 0.70 (0.66-0.74) without and 0.71 (0.67-0.76) with reperfusion therapy. pmc.ncbi.nlm.nih.gov/articles/PMC9238342/
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