The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study Protocol

Abstract

Background and Purpose Epidemiologic studies of intracerebral hemorrhage (ICH) have consistently demonstrated variation in incidence, location, age at presentation, and outcomes among non-Hispanic white, black, and Hispanic populations. We report here the design and methods for this large, prospective, multi-center case-control study of ICH. Methods The ERICH study is a multi-center, prospective case-control study of ICH. Cases are identified by hot-pursuit and enrolled using standard phenotype and risk factor information and include neuroimaging and blood sample collection. Controls are centrally identified by random digit dialing to match cases by age (+/−5 years), race, ethnicity, gender and metropolitan region. Results As of March 22, 2013, 1,655 cases of ICH had been recruited into the study which is 101.5% of the target for that date and 851 controls had been recruited which is 67.2% of the target for that date (1,267 controls) for a total of 2,506 subjects which is 86.5% of the target for that date (2,897 subjects). Of the 1,655 cases enrolled, 1,640 cases had the case interview entered into the database of which 628 (38%) were non-Hispanic black, 458 (28%) were non-Hispanic white and 554 (34%) were Hispanic. Of the 1,197 cases with imaging submitted, 876 (73.2%) had a 24 hour follow-up CT available In addition to CT imaging, 607 cases have had MRI evaluation. Conclusion The ERICH study is a large, case-control study of ICH with particular emphasis on recruitment of minority populations for the identification of genetic and epidemiologic risk factors for ICH and outcomes after ICH.

Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes

“…Each center screened potential patients for parent studies through review of hospital admission, emergency room, and NICU admission logs. 21 Each patient successfully consented for a parent study was then subsequently screened for this study by assessing whether he or she was still within the first 24 hours of hospital admission.…”

“…For patients enrolled in ERICH, baseline CT images were sent to the ERICH neuroimaging core site (Massachusetts General Hospital) for independent assessment of radiographic variables. 21 Patients not enrolled in ERICH had their initial imaging assessed locally by a blinded reviewer.…”

Racial Associations with Hemorrhagic Presentation in Cerebral Arteriovenous Malformations

“…Race was recategorized as white or others based on previous literature that suggests a lower risk of hemorrhagic events in the white population (1,19,21,48). AVM location (frontal, nonfrontal lobar, basal ganglia, brainstem, and cerebellum) was classified into 4 categories to reduce overstratification of the data.…”

Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage

“…20 The goal of the study is to recruit 3,000 patients with primary ICH and 3,000 matched controls from 19 centers in the United States. In addition to the overall goal of identifying genetic variations and other factors that affect ICH risk, ERICH was also designed to explore MRI characteristics of patients with primary ICH.…”