Combining Spot Sign and Intracerebral Hemorrhage Score to Estimate Functional Outcome

Schneider, Hauke; Huynh, Thien; Demchuk, Andrew M.; Dowlatshahi, Dar; Rodríguez‐Luna, David; Silva, Yolanda; Aviv, Richard I.; Dzialowski, Imanuel

doi:10.1161/strokeaha.118.020679

Cited by 10 publications

(10 citation statements)

References 12 publications

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“…Hematoma volume has been established as the strongest independent predictor of clinical outcome following spontaneous ICH and is, therefore, a critical component of all ICH prognostic scores. [4][5][6][25][26][27][28][29] Additional associations between hematoma volume and hematoma location have been identified. 4,11,12,14,30 Because lobar ICH has been consistently associated with improved neurologic outcomes upon comparison to deep ICH, it has been suggested that the higher initial hematoma volumes in lobar ICH may be offset by the poor prognosis associated with increased likelihood of IVH extension in deep ICH.…”

Section: Discussionmentioning

confidence: 99%

Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage

Ironside

Chen

Dreyer

et al. 2019

International Journal of Stroke

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Background and objective Functional outcome after spontaneous intracerebral hemorrhage (ICH) may vary depending on hematoma volume and location. We assessed the interaction between hematoma volume and location, and modified the original ICH score to include such an interaction. Methods Consecutive ICH patients were enrolled in the Intracerebral Hemorrhage Outcomes Project from 2009 to 2017. Inclusion criteria were age≥18 years, baseline modified Rankin Scale (mRS) score 0–2, neuroimaging, and follow-up. Functional dependence and mortality were defined as 90-day mRS>2 and death, respectively. A location ICH score was developed using multivariable regression and area under the receiver operator characteristic curve (AUROC) analyses. Results The study cohort comprised 311 patients, and the derivation and validation cohorts comprised 209 and 102 patients, respectively. Interactions between hematoma volume and location predicted functional dependence ( p = 0.008) and mortality ( p = 0.025). The location ICH score comprised age≥80 years (1 point), Glasgow Coma Scale score (3–9 = 2 points; 10–13 = 1 point), volume–location (lobar:≥24 mL=2 points, 21–24 mL=1 point; deep:≥8 mL=2 points, 7–8 mL=1 point; brainstem:≥6 mL=2 points, 3–6 mL=1 point; cerebellum:≥24 mL=2 points, 12–24 mL=1 point), and intraventricular hemorrhage (1 point). AUROC of the location ICH score was higher in functional dependence (0.883 vs. 0.770, p = 0.002) but not mortality (0.838 vs. 0.841, p = 0.918) discrimination compared to the original ICH score. Conclusions The interaction between hematoma volume and location exerted an independent effect on outcomes. Excellent discrimination of functional dependence and mortality was observed with incorporation of location-specific volume thresholds into a prediction model. Therefore, the volume–location relationship plays an important role in ICH outcome prediction.

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Section: Discussionmentioning

confidence: 99%

Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage

Ironside

Chen

Dreyer

et al. 2019

International Journal of Stroke

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“…Identify the image symmetry of the bilateral hemispheres Extra-axial lesions Epidural and subdural space [29] Interhemispheric fissure Sylvian fissure Ventricles Lateral ventricles Anterior and posterior horns of lateral ventricles Temporal horns of lateral ventricles Fourth ventricle Specific regions Cerebellopontine angle Sella lesion Vessels Hyperdense MCA sign [15] Hyperdense BA sign [14] Veins: Dense sinus signs of CVT [22] Orbital cavity (Ophthalmic vein enlargement, orbital mass) [17] Intra-axial lesion ACA territory PCA territory MCA territory, basal ganglia and thalamus [24] Borderzone areas [26] MCA-ACA border zone MCA-PCA border zone Temporal lobes Mass effect, mid-line shift, or herniation [25] Brain stem Mid-brain Pons Medulla Cerebellum: symmetry, hyperdensity, hypodensity of the cerebellar hemispheres.5. Identify abnormal densities on brain CT [27, 28] Identify hyper-density lesions Hematoma density Physiological calcification density Identify low density lesions Very low density (CSF and old lesions) Low density (edematous lesion and recent infarcts) Identify heterogeneous density lesions Hematoma with blended sign [18], whirl sign [19], spot sign [21], or black hole sign [20] Low density mixed with hyper-density (hemorrhagic infarct) Identify mass-like lesions ABBBC (Air-Blood-Bone-Brain-CSF) mnemonic [30] ACA anterior cerebral artery, CSF cerebrospinal fluid, CT computerized tomography, CVT cerebral venous thrombosis, ID identification, MCA middle cerebral artery, PCA posterior cerebral artery…”

Section: Resultsmentioning

confidence: 99%

Brain computerized tomography reading in suspected acute ischemic stroke patients: what are essentials for medical students?

et al. 2019

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Background Few systematic methods prioritize the image education in medical students (MS). We hope to develop a checklist of brain computerized tomography (CT) reading in patients with suspected acute ischemic stroke (AIS) for MS and primary care (PC) physicians. Methods Our pilot group generated the items indicating specific structures or signs for the checklist of brain CT reading in suspected AIS patients for MS and PC physicians. These items were used in a modified web-based Delphi process using the online software “SurveyMonkey”. In total 15 panelists including neurologists, neurosurgeons, neuroradiologists, and emergency department physicians participated in the modified Delphi process. Each panelist was encouraged to express feedback, agreement or disagreement on the inclusion of each item using a 9-point Likert scale. Items with median scores of 7–9 were included in our final checklist. Results Fifty-two items were initially provided for the first round of the Delphi process. Of these, 35 achieved general agreement of being an essential item for the MS and PC physicians. The other 17 of the 52 items in this round and another two added items suggested by the panelists were further rated in the next round. Finally, 38 items were included in the essential checklist items of brain CT reading in suspected AIS patients for MS and PC physicians. Conclusions We established a reference regarding the essential items of brain CT reading in suspected AIS patients. We hope this helps to minimize malpractice and a delayed diagnosis, and to improve competency-based medical education for MS and PC physicians.

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“…Furthermore, the spot sign helps identify ICH survivors who might require surgical intervention and longer in-patient treatment course. Combining the CTA spot sign with other prognostic tools is also an option [15], but more research on this topic is warranted.…”

Section: Discussionmentioning

confidence: 99%

“…Earlier studies have revealed that the spot sign is associated with higher mortality, hematoma expansion, and worse functional outcomes in patients with ICH, indicating the predictive value of the spot sign. However, these studies determined the endpoint of functional outcome solely based on the mRS score and the study population included patients who died (mRS = 6) during the acute disease phase, which might obscure the predictability of the spot sign in ICH survivors [9,15]. In the present study, we determined functional outcomes based on both BI and mRS scores, which are better in characterizing ADLs.…”

Section: Spot Sign and Functional Outcomesmentioning

confidence: 99%

“…Despite these insights, earlier studies on the CTA spot sign and functional outcomes are limited. These studies used mRS as the only measure of functional outcome, and the calculation of mRS included patients who died (mRS = 6) in the acute phase of the disease [9,15]. Additional evaluation of the association between the CTA spot sign and activities of daily living (ADL) functions in ICH survivors is warranted.…”

Section: Introductionmentioning

confidence: 99%

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Early Spot Sign is Associated with Functional Outcomes in Primary Intracerebral Hemorrhage Survivors

Hsiao

Tseng

Wang

et al. 2020

Preprint

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Background The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and 30-day mortality in intracerebral hemorrhage (ICH). However, whether the spot sign predicts worse functional outcomes among ICH survivors remains unclear. This study investigated the frequency of the spot sign and its association with functional outcomes and length of hospital stay among ICH survivors.Methods This was a retrospective analysis of consecutive patients with primary ICH who received CTA within 24 h from presentation to admission to the emergency department of a single medical center between January 2007 and December 2017. Patients who died before discharge and those referred from other hospitals were excluded. CTAs with motion artifacts were excluded from the analysis. The presence of a spot sign was examined by an experienced neuroradiologist. Functional outcomes were determined based on the modified Rankin Scale (mRS) score and Barthel Index (BI). Severe dependency in activities of daily living (ADL) was defined as BI of ≤60 and severe disability as an mRS score of ≥4. Odds ratio (OR) and multiple linear regression were used as measures of association.Results In total, 66 patients met the inclusion criteria, of whom 9 (13.64%) were positive for a spot sign. No significant differences were observed in baseline characteristics between patients with and without a spot sign. Patients with a spot sign tended to be severely dependent in ADL at discharge (66.67% vs 41.07%; OR = 2.87; p = 0.15) and were more likely to require ICH-related surgery (66.67% vs 24.56%; OR = 6.14; p = 0.01). In multiple linear regression, patients with a higher spot sign score had a significantly longer hospital stay (coefficient = 9.57; 95% CI = 2.11–17.03; p = 0.013).Conclusions The presence of a spot sign is a common finding and is associated with longer hospital stay and possibly worse functional outcomes in ICH survivors.

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Combining Spot Sign and Intracerebral Hemorrhage Score to Estimate Functional Outcome

Abstract: In the PREDICT cohort, a prognostic score adding the computed tomographic angiography-based spot sign to the established ICH score did not improve functional outcome prediction compared with the ICH score.

Cited by 10 publications

References 12 publications

Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage

Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage

Brain computerized tomography reading in suspected acute ischemic stroke patients: what are essentials for medical students?

Early Spot Sign is Associated with Functional Outcomes in Primary Intracerebral Hemorrhage Survivors

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