Joshua VanDerWerf1, Donna Kurowski2, James Siegler2, Taneeta Ganguly2, Brett Cucchiara2. 1. Department of Neurology, Duke University, Duke University Medical Center, 3116 N Duke St, Durham, NC, USA. joshua.vanderwerf@duke.edu. 2. Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: Hematoma expansion (HE) occurs in 1/3 of ICH patients and is associated with poor outcome. Intra-hematomal hypodensity (IHH) on CT has been reported to predict HE, as has the "BRAIN" score. We sought to assess the predictive value of these markers alone and in combination. METHODS: We performed a retrospective single-center study of ICH patients with CT < 6 h from onset. Two blinded neurologists assessed IHH on initial CT. Two HE definitions were examined: > 6 ml and > 6 ml or > 33%. Multivariable logistic regression was used to determine the relationship between IHH and HE. Predictive value of the BRAIN score alone and integrated with IHH was assessed. RESULTS: In 122 included patients, median ICH volume was 13 ml, median time to CT 2.0 h; HE > 6 ml occurred in 31% and > 6 ml/> 33% in 43% of subjects. IHH were identified in 61% of patients with moderate inter-rater agreement (κ = 0.59). In multivariable analysis, IHH was associated with HE using > 6 ml definition (OR 8.3, 95% CI, 2.6-32.8, P < 0.001) but not using the > 6 ml/> 33% definition (OR 1.9, 95% CI 0.84-4.3, P = 0.12). Rate of HE (> 6 ml) increased across increasing BRAIN score quartiles (Q1:11%, Q2:23%, Q3:43%, Q4:57%, P for trend < 0.001). Rate of HE > 6 ml in patients with BRAIN score ≥ 10 and IHH was 55%, with either alone was 33%, and with neither was 3%. CONCLUSIONS: Combining IHH on non-contrast CT and a simple clinical BRAIN score is a potentially powerful way to predict those patients at very high and very low risk of HE.
BACKGROUND:Hematoma expansion (HE) occurs in 1/3 of ICHpatients and is associated with poor outcome. Intra-hematomal hypodensity (IHH) on CT has been reported to predict HE, as has the "BRAIN" score. We sought to assess the predictive value of these markers alone and in combination. METHODS: We performed a retrospective single-center study of ICHpatients with CT < 6 h from onset. Two blinded neurologists assessed IHH on initial CT. Two HE definitions were examined: > 6 ml and > 6 ml or > 33%. Multivariable logistic regression was used to determine the relationship between IHH and HE. Predictive value of the BRAIN score alone and integrated with IHH was assessed. RESULTS: In 122 included patients, median ICH volume was 13 ml, median time to CT 2.0 h; HE > 6 ml occurred in 31% and > 6 ml/> 33% in 43% of subjects. IHH were identified in 61% of patients with moderate inter-rater agreement (κ = 0.59). In multivariable analysis, IHH was associated with HE using > 6 ml definition (OR 8.3, 95% CI, 2.6-32.8, P < 0.001) but not using the > 6 ml/> 33% definition (OR 1.9, 95% CI 0.84-4.3, P = 0.12). Rate of HE (> 6 ml) increased across increasing BRAIN score quartiles (Q1:11%, Q2:23%, Q3:43%, Q4:57%, P for trend < 0.001). Rate of HE > 6 ml in patients with BRAIN score ≥ 10 and IHH was 55%, with either alone was 33%, and with neither was 3%. CONCLUSIONS: Combining IHH on non-contrast CT and a simple clinical BRAIN score is a potentially powerful way to predict those patients at very high and very low risk of HE.
Authors: S M Davis; J Broderick; M Hennerici; N C Brun; M N Diringer; S A Mayer; K Begtrup; T Steiner Journal: Neurology Date: 2006-04-25 Impact factor: 9.910
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
Authors: J Claude Hemphill; Steven M Greenberg; Craig S Anderson; Kyra Becker; Bernard R Bendok; Mary Cushman; Gordon L Fung; Joshua N Goldstein; R Loch Macdonald; Pamela H Mitchell; Phillip A Scott; Magdy H Selim; Daniel Woo Journal: Stroke Date: 2015-05-28 Impact factor: 7.914
Authors: Ryan Wada; Richard I Aviv; Allan J Fox; Demetrios J Sahlas; David J Gladstone; George Tomlinson; Sean P Symons Journal: Stroke Date: 2007-02-22 Impact factor: 7.914
Authors: Christen D Barras; Brian M Tress; Soren Christensen; Lachlan MacGregor; Marnie Collins; Patricia M Desmond; Brett E Skolnick; Stephan A Mayer; Joseph P Broderick; Michael N Diringer; Thorsten Steiner; Stephen M Davis Journal: Stroke Date: 2009-03-12 Impact factor: 7.914
Authors: Brett Kissela; Alexander Schneider; Dawn Kleindorfer; Jane Khoury; Rosemary Miller; Kathleen Alwell; Daniel Woo; Jerzy Szaflarski; James Gebel; Charles Moomaw; Arthur Pancioli; Edward Jauch; Rakesh Shukla; Joseph Broderick Journal: Stroke Date: 2004-02 Impact factor: 7.914
Authors: Viesha A Ciura; H Bart Brouwers; Raffaella Pizzolato; Claudia J Ortiz; Jonathan Rosand; Joshua N Goldstein; Steven M Greenberg; Stuart R Pomerantz; R Gilberto Gonzalez; Javier M Romero Journal: Stroke Date: 2014-10-09 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