Which Intracerebral Bleeds Will Expand?
Brouwers HB, Chang Y, Falcone GJ, et al
JAMA Neurol. 2014;71:158-164
After acute intracerebral hemorrhage (ICH), restricting hematoma expansion is an important objective and a focus of many clinical trials. The goals of this prospective cohort study were to develop and validate a prediction score for identifying patients with primary ICH who were at highest risk for hematoma expansion.
Participants at 2 urban academic medical centers had primary ICH with available baseline and follow-up CT scans for volumetric analysis. There were 817 patients in the development cohort and 195 patients in the independent validation cohort.
Use of semiautomated software allowed measurement of hematoma expansion, defined as more than 6 mL (33%) growth. Univariate and multivariable logistic regression allowed testing of covariates for association with hematoma expansion. This yielded a 9-point prediction score that was subsequently tested in the independent validation cohort.
Nearly one fifth (19.1%) of patients (n = 156) had hematoma expansion. Predictors of expansion, based on multivariable analysis, were warfarin sodium use, the CT angiography spot sign, and shorter time to CT (≤ 6 vs > 6 hours; (P <  .001 for all). Baseline ICH volume was also a predictor. Using < 30 mL as a reference, volumes of 30-60 mL (P = .03) and > 60 mL (P = .005) were predictors of hematoma expansion.
Using these factors in a 9-point prediction score, the investigators showed that the incidence of hematoma expansion increased progressively with higher scores among the development cohort (C statistic, 0.72). The prediction score performed well in the independent validation cohort and was strongly associated with hematoma expansion (odds ratio, 4.59; P < .001 for a high vs low score).
On the basis of readily available data, the investigators have developed and independently validated a 9-point prediction score for hematoma expansion. This score could be clinically useful in individualizing patient management as well as in designing ICH trials. Identifying patients at highest risk for hematoma expansion should help select patients with maximum potential to benefit from treatment interventions.
Abstract
Predicting Hematoma Expansion After Primary Intracerebral Hemorrhage
Brouwers HB, Chang Y, Falcone GJ, et al
JAMA Neurol. 2014;71:158-164
Study Summary
After acute intracerebral hemorrhage (ICH), restricting hematoma expansion is an important objective and a focus of many clinical trials. The goals of this prospective cohort study were to develop and validate a prediction score for identifying patients with primary ICH who were at highest risk for hematoma expansion.
Participants at 2 urban academic medical centers had primary ICH with available baseline and follow-up CT scans for volumetric analysis. There were 817 patients in the development cohort and 195 patients in the independent validation cohort.
Use of semiautomated software allowed measurement of hematoma expansion, defined as more than 6 mL (33%) growth. Univariate and multivariable logistic regression allowed testing of covariates for association with hematoma expansion. This yielded a 9-point prediction score that was subsequently tested in the independent validation cohort.
Nearly one fifth (19.1%) of patients (n = 156) had hematoma expansion. Predictors of expansion, based on multivariable analysis, were warfarin sodium use, the CT angiography spot sign, and shorter time to CT (≤ 6 vs > 6 hours; (P <  .001 for all). Baseline ICH volume was also a predictor. Using < 30 mL as a reference, volumes of 30-60 mL (P = .03) and > 60 mL (P = .005) were predictors of hematoma expansion.
Using these factors in a 9-point prediction score, the investigators showed that the incidence of hematoma expansion increased progressively with higher scores among the development cohort (C statistic, 0.72). The prediction score performed well in the independent validation cohort and was strongly associated with hematoma expansion (odds ratio, 4.59; P < .001 for a high vs low score).
Viewpoint
On the basis of readily available data, the investigators have developed and independently validated a 9-point prediction score for hematoma expansion. This score could be clinically useful in individualizing patient management as well as in designing ICH trials. Identifying patients at highest risk for hematoma expansion should help select patients with maximum potential to benefit from treatment interventions.
Abstract
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