Validation and Comparison of Noncontrast CT Scores to Predict Intracerebral Hemorrhage Expansion.
BAT
BRAIN
HEP
Hematoma expansion
Intracerebral hemorrhage
STROKE
Score
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
pubmed:
26
7
2019
medline:
8
6
2021
entrez:
26
7
2019
Statut:
ppublish
Résumé
The BAT, BRAIN, and HEP scores have been proposed to predict hematoma expansion (HE) with noncontrast computed tomography (NCCT). We sought to validate these tools and compare their diagnostic performance. We retrospectively analyzed two cohorts of patients with primary intracerebral hemorrhage. HE expansion was defined as volume growth > 33% or > 6 mL. Two raters analyzed NCCT scans and calculated the scores, blinded to clinical and imaging data. The inter-rater reliability was assessed with the interclass correlation statistic. Discrimination and calibration were calculated with area under the curve (AUC) and Hosmer-Lemeshow χ A total of 230 subjects were included, of whom 86 (37.4%) experienced HE. The observed AUC for HE were 0.696 for BAT, 0.700 for BRAIN, and 0.648 for HEP. None of the scores had a significantly superior AUC compared with the others (all p > 0.4). All the scores had good calibration (all p > 0.3) and good-to-excellent inter-rater reliability (interclass correlation > 0.8). BAT ≥ 3 showed the highest specificity (0.81), whereas BRAIN ≥ 6 had the highest sensitivity (0.76). The BAT, BRAIN, and HEP scores can predict HE with acceptable discrimination and require just a baseline NCCT scan. These tools may be used to stratify the risk of HE in clinical practice or randomized controlled trials.
Sections du résumé
BACKGROUND AND PURPOSE
The BAT, BRAIN, and HEP scores have been proposed to predict hematoma expansion (HE) with noncontrast computed tomography (NCCT). We sought to validate these tools and compare their diagnostic performance.
METHODS
We retrospectively analyzed two cohorts of patients with primary intracerebral hemorrhage. HE expansion was defined as volume growth > 33% or > 6 mL. Two raters analyzed NCCT scans and calculated the scores, blinded to clinical and imaging data. The inter-rater reliability was assessed with the interclass correlation statistic. Discrimination and calibration were calculated with area under the curve (AUC) and Hosmer-Lemeshow χ
RESULTS
A total of 230 subjects were included, of whom 86 (37.4%) experienced HE. The observed AUC for HE were 0.696 for BAT, 0.700 for BRAIN, and 0.648 for HEP. None of the scores had a significantly superior AUC compared with the others (all p > 0.4). All the scores had good calibration (all p > 0.3) and good-to-excellent inter-rater reliability (interclass correlation > 0.8). BAT ≥ 3 showed the highest specificity (0.81), whereas BRAIN ≥ 6 had the highest sensitivity (0.76).
CONCLUSIONS
The BAT, BRAIN, and HEP scores can predict HE with acceptable discrimination and require just a baseline NCCT scan. These tools may be used to stratify the risk of HE in clinical practice or randomized controlled trials.
Identifiants
pubmed: 31342451
doi: 10.1007/s12028-019-00797-2
pii: 10.1007/s12028-019-00797-2
doi:
Types de publication
Comparative Study
Journal Article
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
804-811Références
Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet. 2009;373(9675):1632–44.
pubmed: 19427958
pmcid: 3138486
Morotti A, Goldstein JN. Diagnosis and management of acute intracerebral hemorrhage. Emerg Med Clin North Am. 2016;34(4):883–99.
pubmed: 27741993
pmcid: 5089075
Dowlatshahi D, Demchuk AM, Flaherty ML, Ali M, Lyden PL, Smith EE. Defining hematoma expansion in intracerebral hemorrhage: relationship with patient outcomes. Neurology. 2011;76(14):1238–44.
pubmed: 21346218
pmcid: 3068004
Steiner T, Bösel J. Options to restrict hematoma expansion after spontaneous intracerebral hemorrhage. Stroke. 2010;41(2):402–9.
pubmed: 20044536
Demchuk AM, Dowlatshahi D, Rodriguez-Luna D, Molina CA, Blas YS, Dzialowski I, 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.
pubmed: 22405630
Romero JM, Bart Brouwers H, Lu J, Almandoz JED, Kelly H, Heit J, et al. Prospective validation of the computed tomographic angiography spot sign score for Intracerebral hemorrhage. Stroke. 2013;44(11):3097–102.
pubmed: 24021687
pmcid: 4187102
Brouwers HB, Chang Y, Falcone GJ, Cai X, Ayres AM, Battey TWK, et al. Predicting hematoma expansion after primary intracerebral hemorrhage. JAMA Neurol. 2014;71(2):158.
pubmed: 24366060
pmcid: 4131760
Morotti A, Brouwers HB, Romero JM, Jessel MJ, Vashkevich A, Schwab K, et al. Intensive blood pressure reduction and spot sign in intracerebral hemorrhage. JAMA Neurol. 2017;74(8):950.
pubmed: 28628707
pmcid: 5584592
Boulouis G, Morotti A, Charidimou A, Dowlatshahi D, Goldstein JN. Noncontrast computed tomography markers of intracerebral hemorrhage expansion. Stroke. 2017;48(4):1120–5.
pubmed: 28289239
pmcid: 5378158
Wang X, Arima H, Al-Shahi Salman R, Woodward M, Heeley E, Stapf C, et al. Clinical prediction algorithm (BRAIN) to determine risk of hematoma growth in acute intracerebral hemorrhage. Stroke. 2015;46(2):376–81.
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.
pubmed: 25963292
Morotti A, Dowlatshahi D, Boulouis G, Al-Ajlan F, Demchuk AM, Aviv RI, et al. Predicting intracerebral hemorrhage expansion with noncontrast computed tomography: the BAT score. Stroke. 2018;49(5):1163–9.
pubmed: 29669875
pmcid: 6034631
Pezzini A, Grassi M, Paciaroni M, Zini A, Silvestrelli G, Iacoviello L, et al. Obesity and the risk of intracerebral hemorrhage: the multicenter study on cerebral hemorrhage in Italy. Stroke. 2013;44(6):1584–9.
pubmed: 23549133
Pezzini A, Grassi M, Iacoviello L, Zedde M, Marcheselli S, Silvestrelli G, et al. Serum cholesterol levels, HMG-CoA reductase inhibitors and the risk of intracerebral haemorrhage. The Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy). J Neurol Neurosurg Psychiatry. 2016;87(9):924–9.
pubmed: 27003275
Hemphill JC, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032–60.
pubmed: 26022637
Li Q, Zhang G, Huang Y-J, Dong M-X, Lv F-J, Wei X, et al. Blend sign on computed tomography: novel and reliable predictor for early hematoma growth in patients with intracerebral hemorrhage. Stroke. 2018;49(5):1163–9.
Boulouis G, Morotti A, Brouwers HB, Charidimou A, Jessel MJ, Auriel E, et al. Association between hypodensities detected by computed tomography and hematoma expansion in patients with intracerebral hemorrhage. JAMA Neurol. 2016;73(8):961.
pubmed: 27323314
pmcid: 5584601
Hallgren KA. Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol. 2012;8(1):23–34.
pubmed: 22833776
pmcid: 3402032
Steyerberg EW, Vickers AJ, Cook NR, Gerds T, Gonen M, Obuchowski N, et al. Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology. 2010;21(1):128–38.
pubmed: 20010215
pmcid: 3575184
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.
Lord AS, Gilmore E, Choi HA, Mayer SA. Time course and predictors of neurological deterioration after intracerebral hemorrhage. Stroke. 2015;46(3):647–52.
pubmed: 25657190
pmcid: 4739782
Sprigg N, Flaherty K, Appleton JP, Salman RA-S, Bereczki D, Beridze M, et al. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet. 2018;391(10135):2107–15.
pubmed: 29778325
pmcid: 5976950
Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375(11):1033–43.
pubmed: 27276234
pmcid: 5345109
Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368(25):2355–65.
pubmed: 23713578
Mayer SA, Brun NC, Begtrup K, Broderick J, Davis S, Diringer MN, et al. Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. 2008;358(20):2127–37.
pubmed: 18480205
pmcid: 18480205
Inoue Y, Miyashita F, Koga M, Minematsu K, Toyoda K. Unclear-onset intracerebral hemorrhage: clinical characteristics, hematoma features, and outcomes. Int J Stroke. 2017;12(9):961–8.
pubmed: 28361615
Fassbender K, Grotta JC, Walter S, Grunwald IQ, Ragoschke-Schumm A, Saver JL. Mobile stroke units for prehospital thrombolysis, triage, and beyond: benefits and challenges. Lancet Neurol. 2017;16(3):227–37.
pubmed: 28229894
Morotti A, Boulouis G, Romero JM, Brouwers HB, Jessel MJ, Vashkevich A, et al. Blood pressure reduction and noncontrast CT markers of intracerebral hemorrhage expansion. Neurology. 2017;89(6):548–54.
pubmed: 28701501
pmcid: 5562954
Boulouis G, Charidimou A, Morotti A. Consensus needed for noncontrast CT markers in intracerebral hemorrhage. Am J Neuroradiol. 2018;39(6):E78–9.
pubmed: 29700049
Huttner HB, Steiner T, Hartmann M, Köhrmann M, Juettler E, Mueller S, et al. Comparison of ABC/2 estimation technique to computer-assisted planimetric analysis in warfarin-related intracerebral parenchymal hemorrhage. Stroke. 2006;37(2):404–8.
pubmed: 16373654
Morotti A, Boulouis G, Charidimou A, Schwab K, Kourkoulis C, Anderson CD, et al. Integration of computed tomographic angiography spot sign and noncontrast computed tomographic hypodensities to predict hematoma expansion. Stroke. 2018;49(9):2067–73.
pubmed: 30354976
pmcid: 6206864
Yu Z, Zheng J, Xia F, Guo R, Ma L, You C, et al. BAT score versus spot sign in predicting intracerebral hemorrhage expansion. World Neurosurg. 2019;126:e694–8. https://doi.org/10.1016/j.wneu.2019.02.125 .
pubmed: 30844526
Yogendrakumar V, Ramsay T, Fergusson DA, Demchuk AM, Aviv RI, Rodriguez-Luna D, et al. Independent validation of the hematoma expansion prediction score: a non-contrast score equivalent in accuracy to the spot sign. Neurocrit Care. 2019. https://doi.org/10.1007/s12028-019-00740-5 .
pubmed: 31123995
Al-Shahi Salman R, Frantzias J, Lee RJ, Lyden PD, Battey TWK, Ayres AM, 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.
pubmed: 30120039
pmcid: 6143589
Huynh TJ, Aviv RI, Dowlatshahi D, Gladstone DJ, Laupacis A, Kiss A, 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.
pubmed: 26463691
Lim JX, Han JX, See AAQ, Lew VH, Chock WT, Ban VF, et al. External validation of hematoma expansion scores in spontaneous intracerebral hemorrhage in an Asian patient cohort. Neurocrit Care. 2018;30:394–404.
Hilkens NA, van Asch CJJ, Werring DJ, Wilson D, Rinkel GJE, Algra A, et al. Predicting the presence of macrovascular causes in non-traumatic intracerebral haemorrhage: the DIAGRAM prediction score. J Neurol Neurosurg Psychiatry. 2018;89(7):674–9.
pubmed: 29348301