Thien J Huynh1, Richard I Aviv2, Dar Dowlatshahi2, David J Gladstone2, Andreas Laupacis2, Alex Kiss2, Michael D Hill2, Carlos A Molina2, David Rodriguez-Luna2, Imanuel Dzialowski2, Yolanda Silva2, Adam Kobayashi2, Cheemun Lum2, Jean-Martin Boulanger2, Gord Gubitz2, Rohit Bhatia2, Vasantha Padma2, Jayanta Roy2, Carlos S Kase2, Sean P Symons2, Andrew M Demchuk2. 1. From the Division of Neuroradiology and Department of Medical Imaging (T.J.H., R.I.A., S.P.S.) and Division of Neurology, Department of Medicine and Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Calgary Stroke Program, Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada (M.D.H., A.M.D.); Department of Medicine (Neurology) (D.D.) and Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital (C.L.), University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine and Institute of Health Policy Management and Evaluation, University of Toronto and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada (A.L.); Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada (A.K.); Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (C.A.M., D.R.-L.); Department Neurology, Elblandklinikum Meissen, Academic Teaching Hospital of University of Dresden, Meissen, Germany (I.D.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona (IDIBGi) Foundation, Girona, Spain (Y.S.); Second Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, Warsaw, Poland (A.K.); Department of Medicine, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, Canada (J.-M.B.); Division of Neurology, Department of Medicine, Dalhousie University, Halifax, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); Department of Neuromedicine, AMRI Hospitals, Mukundapur, Kolkata, India (J.R.); and Department of Neurology, Boston Medical Center, MA (C.S.K.). thien.huynh@utoronto.ca. 2. From the Division of Neuroradiology and Department of Medical Imaging (T.J.H., R.I.A., S.P.S.) and Division of Neurology, Department of Medicine and Brain Sciences Program (D.J.G.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Calgary Stroke Program, Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada (M.D.H., A.M.D.); Department of Medicine (Neurology) (D.D.) and Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital (C.L.), University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine and Institute of Health Policy Management and Evaluation, University of Toronto and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada (A.L.); Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada (A.K.); Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (C.A.M., D.R.-L.); Department Neurology, Elblandklinikum Meissen, Academic Teaching Hospital of University of Dresden, Meissen, Germany (I.D.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona (IDIBGi) Foundation, Girona, Spain (Y.S.); Second Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, Warsaw, Poland (A.K.); Department of Medicine, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, Canada (J.-M.B.); Division of Neurology, Department of Medicine, Dalhousie University, Halifax, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); Department of Neuromedicine, AMRI Hospitals, Mukundapur, Kolkata, India (J.R.); and Department of Neurology, Boston Medical Center, MA (C.S.K.).
Abstract
BACKGROUND AND PURPOSE: Nine- and 24-point prediction scores have recently been published to predict hematoma expansion (HE) in acute intracerebral hemorrhage. We sought to validate these scores and perform an independent analysis of HE predictors. METHODS: We retrospectively studied 301 primary or anticoagulation-associated intracerebral hemorrhage patients presenting <6 hours post ictus prospectively enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus Computed Tomography (PREDICT) study. Patients underwent baseline computed tomography angiography and 24-hour noncontrast computed tomography follow-up for HE analysis. Discrimination and calibration of the 9- and 24-point scores was assessed. Independent predictors of HE were identified using multivariable regression and incorporated into the PREDICT A/B scores, which were then compared with existing scores. RESULTS: The 9- and 24-point HE scores demonstrated acceptable discrimination for HE>6 mL or 33% and >6 mL, respectively (area under the curve of 0.706 and 0.755, respectively). The 24-point score demonstrated appropriate calibration in the PREDICT cohort (χ2 statistic, 11.5; P=0.175), whereas the 9-point score demonstrated poor calibration (χ2 statistic, 34.3; P<0.001). Independent HE predictors included spot sign number, time from onset, warfarin use or international normalized ratio>1.5, Glasgow Coma Scale, and National Institutes of Health Stroke Scale and were included in PREDICT A/B scores. PREDICT A showed improved discrimination compared with both existing scores, whereas performance of PREDICT B varied by definition of expansion. CONCLUSIONS: The 9- and 24-point expansion scores demonstrate acceptable discrimination in an independent multicenter cohort; however, calibration was suboptimal for the 9-point score. The PREDICT A score showed improved discrimination for HE prediction but requires independent validation.
BACKGROUND AND PURPOSE: Nine- and 24-point prediction scores have recently been published to predict hematoma expansion (HE) in acute intracerebral hemorrhage. We sought to validate these scores and perform an independent analysis of HE predictors. METHODS: We retrospectively studied 301 primary or anticoagulation-associated intracerebral hemorrhagepatients presenting <6 hours post ictus prospectively enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus Computed Tomography (PREDICT) study. Patients underwent baseline computed tomography angiography and 24-hour noncontrast computed tomography follow-up for HE analysis. Discrimination and calibration of the 9- and 24-point scores was assessed. Independent predictors of HE were identified using multivariable regression and incorporated into the PREDICT A/B scores, which were then compared with existing scores. RESULTS: The 9- and 24-point HE scores demonstrated acceptable discrimination for HE>6 mL or 33% and >6 mL, respectively (area under the curve of 0.706 and 0.755, respectively). The 24-point score demonstrated appropriate calibration in the PREDICT cohort (χ2 statistic, 11.5; P=0.175), whereas the 9-point score demonstrated poor calibration (χ2 statistic, 34.3; P<0.001). Independent HE predictors included spot sign number, time from onset, warfarin use or international normalized ratio>1.5, Glasgow Coma Scale, and National Institutes of Health Stroke Scale and were included in PREDICT A/B scores. PREDICT A showed improved discrimination compared with both existing scores, whereas performance of PREDICT B varied by definition of expansion. CONCLUSIONS: The 9- and 24-point expansion scores demonstrate acceptable discrimination in an independent multicenter cohort; however, calibration was suboptimal for the 9-point score. The PREDICT A score showed improved discrimination for HE prediction but requires independent validation.
Authors: Andrea Morotti; Chia-Ling Phuah; Christopher D Anderson; Michael J Jessel; Kristin Schwab; Alison M Ayres; Alessandro Pezzini; Alessandro Padovani; M Edip Gurol; Anand Viswanathan; Steven M Greenberg; Joshua N Goldstein; Jonathan Rosand Journal: Stroke Date: 2016-04-21 Impact factor: 7.914
Authors: Gregoire Boulouis; Andrea Morotti; H Bart Brouwers; Andreas Charidimou; Michael J Jessel; Eitan Auriel; Octávio Pontes-Neto; Alison Ayres; Anastasia Vashkevich; Kristin M Schwab; Jonathan Rosand; Anand Viswanathan; Mahmut E Gurol; Steven M Greenberg; Joshua N Goldstein Journal: JAMA Neurol Date: 2016-08-01 Impact factor: 18.302
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Authors: Andrea Morotti; Dar Dowlatshahi; Gregoire Boulouis; Fahad Al-Ajlan; Andrew M Demchuk; Richard I Aviv; Liyang Yu; Kristin Schwab; Javier M Romero; M Edip Gurol; Anand Viswanathan; Christopher D Anderson; Yuchiao Chang; Steven M Greenberg; Adnan I Qureshi; Jonathan Rosand; Joshua N Goldstein Journal: Stroke Date: 2018-04-18 Impact factor: 7.914
Authors: Jia Xu Lim; Julian Xinguang Han; Angela An Qi See; Voon Hao Lew; Wan Ting Chock; Vin Fei Ban; Sohil Pothiawala; Winston Eng Hoe Lim; Louis Elliot McAdory; Michael Lucas James; Nicolas Kon Kam King Journal: Neurocrit Care Date: 2019-04 Impact factor: 3.210
Authors: Dar Dowlatshahi; H Bart Brouwers; Andrew M Demchuk; Michael D Hill; Richard I Aviv; Lee-Anne Ufholz; Michael Reaume; Max Wintermark; J Claude Hemphill; Yasuo Murai; Yongjun Wang; Xingquan Zhao; Yilong Wang; Na Li; Takatoshi Sorimachi; Mitsunori Matsumae; Thorsten Steiner; Timolaos Rizos; Steven M Greenberg; Javier M Romero; Jonathan Rosand; Joshua N Goldstein; Mukul Sharma Journal: Stroke Date: 2016-02-04 Impact factor: 7.914
Authors: Vignan Yogendrakumar; Tim Ramsay; Dean A Fergusson; Andrew M Demchuk; Richard I Aviv; David Rodriguez-Luna; Carlos A Molina; Yolanda Silva Blas; Imanuel Dzialowski; Adam Kobayashi; Jean-Martin Boulanger; Cheemun Lum; Gord Gubitz; Padma Srivastava; Jayanta Roy; Carlos S Kase; Rohit Bhatia; Michael D Hill; Magdy Selim; Dar Dowlatshahi Journal: Neurocrit Care Date: 2019-08 Impact factor: 3.210