🧭 REBEL Rundown
🗝️ Key Points
- 🧠 HAT and SEDAN help estimate symptomatic intracranial hemorrhage risk after stroke thrombolysis and can support real-time bedside counseling.
- ⚡ HAT is faster and simpler, making it useful when you need a quick estimate with basic clinical and CT data.
- 🖥️ SEDAN adds more imaging detail, which may provide a more refined risk estimate when CT findings are well characterized.
- ⚠️ These scores are adjuncts, not gatekeepers and should not be used alone to deny thrombolytics to otherwise appropriate patients.
- 🗣️ Best use case: inform shared decision-making, set expectations with families, and guide post-treatment monitoring.
🤕 Case
A 68-year-old man presents with right-sided weakness and slurred speech (NIHSS 12), with a negative CT, making him a clear thrombolytic candidate. As you review the risks and benefits, she seems to be on board, but asks, “What’s his chance of bleeding? Do you think it’s worth it?” You step out briefly, pull up MDCalc to better individualize the risk.
🔗 Scoring Tools
🎯 Quick Hits
💬 Case Resolution
You review his hemorrhage risk using HAT and, given detailed CT findings are available, apply SEDAN for a more refined estimate. After a brief discussion, she agrees to proceed, and thrombolytics are administered without delay.
🚨 Clinical Bottom Line
Use the HAT or SEDAN score to quickly estimate the risk of symptomatic intracranial hemorrhage after stroke thrombolysis and to support bedside counseling, shared decision-making, and post-treatment monitoring. These tools help frame risk, but they should not be used in isolation to withhold thrombolytics from otherwise appropriate patients.
Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_Propersi), and Mark Ramzy, DO (X: @MRamzyDO)
❓ FAQ
- When should I use HAT or SEDAN?
Use these scores when considering thrombolytics for acute ischemic stroke and you want to estimate symptomatic intracranial hemorrhage risk to support bedside counseling and monitoring. - How do HAT and SEDAN differ?
HAT is faster and simpler, using core clinical data and basic CT findings. SEDAN is more detailed and incorporates additional CT features for a more imaging-informed estimate. - Should these scores determine whether a patient gets thrombolytics?
No. They are decision-support tools meant to inform discussion and monitoring, not to withhold treatment from otherwise appropriate patients. - What are the main limitations of these scores?
Both rely on CT interpretation, which can be subjective, and their performance may vary across patient populations. They also use different definitions of symptomatic intracranial hemorrhage. - How should I use the result in practice?
Use the score to frame the risk-benefit discussion with patients and families, individualize counseling, and guide post-thrombolytic monitoring.
🧭 Prep Sheets
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