Independent Validation of the Hematoma Expansion Prediction Score: A Non-contrast Score Equivalent in Accuracy to the Spot Sign.
Computed tomography
Computed tomography angiography
Hematoma expansion
Intracerebral hemorrhage
Prediction
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
pubmed:
28
5
2019
medline:
16
5
2020
entrez:
25
5
2019
Statut:
ppublish
Résumé
The computed tomography angiography (CTA) spot sign is widely used to assess the risk of hematoma expansion following acute intracerebral hemorrhage (ICH). However, not all patients can receive intravenous contrast nor are all hospital systems equipped with this technology. We aimed to independently validate the Hematoma Expansion Prediction (HEP) Score, an 18-point non-contrast prediction scale, in an external cohort and compare its diagnostic capability to the CTA spot sign. We performed a retrospective analysis of the predicting hematoma growth and outcome in intracerebral hemorrhage using contrast bolus CT (PREDICT) Cohort Study. Primary outcome was significant hematoma expansion (≥ 6 mL or ≥ 33%). We generated a receiver operating characteristic (ROC) curve comparing the HEP score to significant expansion. We calculated sensitivity, specificity, positive and negative predictive values (PPV/NPV) for each score point. We determined independent predictors of significant hematoma expansion via logistic regression. A total of 292 patients were included in primary analysis. Hematoma growth of ≥ 6 mL or ≥ 33% occurred in 94 patients (32%). The HEP score was associated with significant expansion (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.01-1.30). ROC curves comparing HEP score to significant expansion had an area under the curve of 0.64 (95% CI 0.57-0.71). Youden's method showed an optimum score of 4. HEP Scores ≥ 4 (n = 100, sensitivity 49%, specificity 73%, PPV 46%, NPV 75%, aOR 1.99, 95% CI 1.09-3.64) accurately predicted significant expansion. PPV increased with higher HEP scores, but at the cost of lower sensitivity. The diagnostic characteristics of the spot sign (n = 82, Sensitivity 49%, Specificity 81%, PPV 55%, NPV 76%, aOR 2.95, 95% CI 1.61-5.42) were similar to HEP scores ≥ 4. The HEP score is predictive of significant expansion (≥ 6 mL or ≥ 33%) and is comparable to the spot sign in diagnostic accuracy. Non-contrast prediction tools may have a potential role in the recruitment of patients in future intracerebral hemorrhage trials.
Sections du résumé
BACKGROUND AND PURPOSE
The computed tomography angiography (CTA) spot sign is widely used to assess the risk of hematoma expansion following acute intracerebral hemorrhage (ICH). However, not all patients can receive intravenous contrast nor are all hospital systems equipped with this technology. We aimed to independently validate the Hematoma Expansion Prediction (HEP) Score, an 18-point non-contrast prediction scale, in an external cohort and compare its diagnostic capability to the CTA spot sign.
METHODS
We performed a retrospective analysis of the predicting hematoma growth and outcome in intracerebral hemorrhage using contrast bolus CT (PREDICT) Cohort Study. Primary outcome was significant hematoma expansion (≥ 6 mL or ≥ 33%). We generated a receiver operating characteristic (ROC) curve comparing the HEP score to significant expansion. We calculated sensitivity, specificity, positive and negative predictive values (PPV/NPV) for each score point. We determined independent predictors of significant hematoma expansion via logistic regression.
RESULTS
A total of 292 patients were included in primary analysis. Hematoma growth of ≥ 6 mL or ≥ 33% occurred in 94 patients (32%). The HEP score was associated with significant expansion (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.01-1.30). ROC curves comparing HEP score to significant expansion had an area under the curve of 0.64 (95% CI 0.57-0.71). Youden's method showed an optimum score of 4. HEP Scores ≥ 4 (n = 100, sensitivity 49%, specificity 73%, PPV 46%, NPV 75%, aOR 1.99, 95% CI 1.09-3.64) accurately predicted significant expansion. PPV increased with higher HEP scores, but at the cost of lower sensitivity. The diagnostic characteristics of the spot sign (n = 82, Sensitivity 49%, Specificity 81%, PPV 55%, NPV 76%, aOR 2.95, 95% CI 1.61-5.42) were similar to HEP scores ≥ 4.
CONCLUSION
The HEP score is predictive of significant expansion (≥ 6 mL or ≥ 33%) and is comparable to the spot sign in diagnostic accuracy. Non-contrast prediction tools may have a potential role in the recruitment of patients in future intracerebral hemorrhage trials.
Identifiants
pubmed: 31123995
doi: 10.1007/s12028-019-00740-5
pii: 10.1007/s12028-019-00740-5
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1-8Références
Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet (London, England). 2009;373(9675):1632–44.
doi: 10.1016/S0140-6736(09)60371-8
Gonzales NR. Ongoing clinical trials in intracerebral hemorrhage. Stroke. 2013;44(6 Suppl 1):S70–3.
doi: 10.1161/STROKEAHA.111.000563
pubmed: 23709737
VanDerWerf J, Kurowski D, Siegler J, Ganguly T, Cucchiara B. Combination of intra-hematomal hypodensity on CT and BRAIN scoring improves prediction of hemorrhage expansion in ICH. Neurocrit Care. 2018;29:40–6.
doi: 10.1007/s12028-018-0507-y
pubmed: 29411303
Morotti A, Dowlatshahi D, Boulouis G, et al. Predicting intracerebral hemorrhage expansion with noncontrast computed tomography: the BAT Score. Stroke. 2018;49(5):1163–9.
doi: 10.1161/STROKEAHA.117.020138
pubmed: 29669875
pmcid: 6034631
Huynh TJ, Aviv RI, Dowlatshahi D, et al. Validation of the 9-point and 24-Point Hematoma Expansion Prediction Scores and derivation of the PREDICT A/B Scores. Stroke. 2015;46(11):3105–10.
doi: 10.1161/STROKEAHA.115.009893
pubmed: 26463691
Delgado Almandoz JE, Yoo AJ, Stone MJ, et al. The spot sign score in primary intracerebral hemorrhage identifies patients at highest risk of in-hospital mortality and poor outcome among survivors. Stroke. 2010;41(1):54–60.
doi: 10.1161/STROKEAHA.109.565382
pubmed: 19910545
Wang X, Arima H, Al-Shahi Salman R, et al. Clinical prediction algorithm (BRAIN) to determine risk of hematoma growth in acute intracerebral hemorrhage. Stroke. 2015;46(2):376–81.
doi: 10.1161/STROKEAHA.114.006910
pubmed: 25503550
Yao X, Xu Y, Siwila-Sackman E, Wu B, Selim M. The HEP Score: a nomogram-derived Hematoma Expansion Prediction Scale. Neurocrit Care. 2015;23(2):179–87.
doi: 10.1007/s12028-015-0147-4
pubmed: 25963292
Meretoja A, Churilov L, Campbell BCV, et al. The spot sign and tranexamic acid on preventing ICH growth–AUStralasia Trial (STOP-AUST): protocol of a phase II randomized, placebo-controlled, double-blind, multicenter trial. Int J Stroke. 2014;9(4):519–24.
doi: 10.1111/ijs.12132
pubmed: 23981692
Demchuk AM, Dowlatshahi D, Rodriguez-Luna D, et al. Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study. Lancet Neurol. 2012;11(4):307–14.
doi: 10.1016/S1474-4422(12)70038-8
pubmed: 22405630
Dowlatshahi D, Demchuk AM, Flaherty ML, et al. Defining hematoma expansion in intracerebral hemorrhage: relationship with patient outcomes. Neurology. 2011;76(14):1238–44.
doi: 10.1212/WNL.0b013e3182143317
pubmed: 21346218
pmcid: 3068004
Royston P, Ambler G, Sauerbrei W. The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol. 1999;28(5):964–74.
doi: 10.1093/ije/28.5.964
pubmed: 10597998
Al-Shahi Salman R, Frantzias J, Lee RJ, et al. Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. Lancet Neurol. 2018;17(10):885–94.
doi: 10.1016/S1474-4422(18)30253-9
pubmed: 30120039
pmcid: 6143589
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45.
doi: 10.2307/2531595
Dowlatshahi D, Smith EE, Flaherty ML, et al. Small intracerebral haemorrhages are associated with less haematoma expansion and better outcomes. Int J Stroke. 2011;6(3):201–6.
doi: 10.1111/j.1747-4949.2010.00563.x
pubmed: 21557804
Dowlatshahi D, Yogendrakumar V, Aviv RIRI, et al. Small intracerebral hemorrhages have a low spot sign prevalence and are less likely to expand. Int J Stroke. 2016;11(2):191–7.
doi: 10.1177/1747493015616635
pubmed: 26783310
Schlegel D, Kolb SJ, Luciano JM, et al. Utility of the NIH Stroke Scale as a predictor of hospital disposition. Stroke. 2003;34(1):134–7.
doi: 10.1161/01.STR.0000048217.44714.02
pubmed: 12511764
Balami JS, Buchan AM. Complications of intracerebral haemorrhage. Lancet Neurol. 2012;11(1):101–18.
doi: 10.1016/S1474-4422(11)70264-2
pubmed: 22172625
Kazui S, Naritomi H, Yamamoto H, Sawada T, Yamaguchi T. Enlargement of spontaneous intracerebral hemorrhage. Incidence and time course. Stroke. 1996;27(10):1783–7.
doi: 10.1161/01.STR.27.10.1783
pubmed: 8841330
Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997;28(1):1–5.
doi: 10.1161/01.STR.28.1.1
pubmed: 8996478
Kuramatsu JB, Gerner ST, Schellinger PD, et al. Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA. 2015;313(8):824–36.
doi: 10.1001/jama.2015.0846
pubmed: 25710659
Cordonnier C, Leys D, Dumont F, et al. What are the causes of pre-existing dementia in patients with intracerebral haemorrhages? Brain. 2010;133(11):3281–9.
doi: 10.1093/brain/awq246
pubmed: 20852266
Rodrigues MA, Samarasekera N, Lerpiniere C, et al. The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study. Lancet Neurol. 2018;17(3):232–40.
doi: 10.1016/S1474-4422(18)30006-1
pubmed: 29331631
pmcid: 5818029
Boulouis G, Morotti A, Charidimou A, Dowlatshahi D, Goldstein JN. Noncontrast computed tomography markers of intracerebral hemorrhage expansion. Stroke. 2017;48(4):1120–5.
doi: 10.1161/STROKEAHA.116.015062
pubmed: 28289239
pmcid: 5378158
Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993;24(7):987–93.
doi: 10.1161/01.STR.24.7.987