Andrea Morotti1, Dar Dowlatshahi2, Gregoire Boulouis3, Fahad Al-Ajlan4, Andrew M Demchuk5, Richard I Aviv5, Liyang Yu6, Kristin Schwab7, Javier M Romero7,8, M Edip Gurol7, Anand Viswanathan7, Christopher D Anderson7,9, Yuchiao Chang6, Steven M Greenberg7, Adnan I Qureshi10, Jonathan Rosand7,9, Joshua N Goldstein7,9,11. 1. From the Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy (A.M.); Department of Medicine (Neurology), University of Ottawa, Ottawa Hospital Research Institute, Canada (D.D., F.A.-A.). 2. Department of Neuroradiology, Université Paris Descartes, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, France (G.B.) ddowlat@ottawahospital.on.ca. 3. Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Canada (A.M.D.). 4. Department of Neuroradiology, Université Paris Descartes, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, France (G.B.). 5. Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Canada (R.I.A.). 6. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (L.Y., Y.C.). 7. J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.M.R., K.S., M.E.G., A.V., C.D.A., S.M.G., J.R., J.N.G.). 8. Neuroradiology Service, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.M.R.). 9. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.D.A., J.R., J.N.G.). 10. Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis (A.I.Q.). 11. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.N.G.).
Abstract
BACKGROUND AND PURPOSE: Although the computed tomographic angiography spot sign performs well as a biomarker for hematoma expansion (HE), computed tomographic angiography is not routinely performed in the emergency setting. We developed and validated a score to predict HE-based on noncontrast computed tomography (NCCT) findings in spontaneous acute intracerebral hemorrhage. METHODS: After developing the score in a single-center cohort of patients with intracerebral hemorrhage (n=344), we validated it in a large clinical trial population (n=954) and in a multicenter intracerebral hemorrhage cohort (n=241). The following NCCT markers of HE were analyzed: hypodensities, blend sign, hematoma shape and density, and fluid level. HE was defined as hematoma growth >6 mL or >33%. The score was created using the estimates from multivariable logistic regression after final predictors were selected from bootstrap samples. RESULTS: Presence of blend sign (odds ratio, 3.09; 95% confidence interval [CI],1.49-6.40; P=0.002), any intrahematoma hypodensity (odds ratio, 4.54; 95% CI, 2.44-8.43; P<0.0001), and time from onset to NCCT <2.5 hours (odds ratio, 3.73; 95% CI, 1.86-7.51; P=0.0002) were predictors of HE. A 5-point score was created (BAT score: 1 point for blend sign, 2 points for any hypodensity, and 2 points for timing of NCCT <2.5 hours). The c statistic was 0.77 (95% CI, 0.70-0.83) in the development population, 0.65 (95% CI 0.61-0.68) and 0.70 (95% CI, 0.64-0.77) in the 2 validation cohorts. A dichotomized score (BAT score ≥3) predicted HE with 0.50 sensitivity and 0.89 specificity. CONCLUSIONS: An easy to use 5-point prediction score can identify subjects at high risk of HE with good specificity and accuracy. This tool requires just a baseline NCCT scan and may help select patients with intracerebral hemorrhage for antiexpansion clinical trials.
BACKGROUND AND PURPOSE: Although the computed tomographic angiography spot sign performs well as a biomarker for hematoma expansion (HE), computed tomographic angiography is not routinely performed in the emergency setting. We developed and validated a score to predict HE-based on noncontrast computed tomography (NCCT) findings in spontaneous acute intracerebral hemorrhage. METHODS: After developing the score in a single-center cohort of patients with intracerebral hemorrhage (n=344), we validated it in a large clinical trial population (n=954) and in a multicenter intracerebral hemorrhage cohort (n=241). The following NCCT markers of HE were analyzed: hypodensities, blend sign, hematoma shape and density, and fluid level. HE was defined as hematoma growth >6 mL or >33%. The score was created using the estimates from multivariable logistic regression after final predictors were selected from bootstrap samples. RESULTS: Presence of blend sign (odds ratio, 3.09; 95% confidence interval [CI],1.49-6.40; P=0.002), any intrahematoma hypodensity (odds ratio, 4.54; 95% CI, 2.44-8.43; P<0.0001), and time from onset to NCCT <2.5 hours (odds ratio, 3.73; 95% CI, 1.86-7.51; P=0.0002) were predictors of HE. A 5-point score was created (BAT score: 1 point for blend sign, 2 points for any hypodensity, and 2 points for timing of NCCT <2.5 hours). The c statistic was 0.77 (95% CI, 0.70-0.83) in the development population, 0.65 (95% CI 0.61-0.68) and 0.70 (95% CI, 0.64-0.77) in the 2 validation cohorts. A dichotomized score (BAT score ≥3) predicted HE with 0.50 sensitivity and 0.89 specificity. CONCLUSIONS: An easy to use 5-point prediction score can identify subjects at high risk of HE with good specificity and accuracy. This tool requires just a baseline NCCT scan and may help select patients with intracerebral hemorrhage for antiexpansion clinical trials.
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