The IVH Score: A novel tool for estimating intraventricular hemorrhage volume: Clinical and research implications*

Abstract

Objective-Intraventricular extension of intracerebral hemorrhage (IVH) is an independent predictor of poor outcome. IVH volume may be important in outcome prediction and management; however, it is difficult to measure routinely.Design and Patients-We reviewed the charts and computed tomographies of a cohort of consecutive patients with IVH. The cohort was divided into two groups: index and validation by random sampling. IVH and intracerebral hemorrhage (ICH) volume were measured manually in all patients. IVH was also graded using a simple classification system termed IVH score (IVHS). Clinical outcome was determined by the modified Rankin Scale (mRS) at discharge and in-hospital death. Poor outcome was defined as mRS 4-6.Main Results-One hundred seventy-five patients were analyzed, 92 in the index group and 83 in the validation group. Exponential regression yielded the following formula for estimating IVH volume (mL): eÎVHS/5 (R 2 = .75, p < 0.001). The IVH estimation formula was then verified in the validation group (R 2 = .8, p < 0.001). The following correlations with mRS were obtained: IVH volume R = .305; ICH volume R = .468; total volume [TV] R = .571 (p < 0.001 for all three correlations). Partial correlation of TV with mRS controlling for ICH volume yielded R = .3 for TV (p < 0.001). Logistic regression model comparing ICH and TV association with poor outcome yielded the following: ICH odds ratio = 5.2, 95% confidence interval 2.3-11.6, p < 0.001; TV odds ratio = 41.6, 95% confidence interval 9.6-180.6, p < 0.001. Substituting TV for ICH volume in the ICH score resulted in a significant increase in the specificity from 64% to 87% for predicting mortality. (7) is a known independent predictor of poor outcome (1,(7)(8)(9)(10)(11)(12)(13)(14) and several studies have demonstrated a direct relation between IVH volume and poor outcome or mortality (20,25,26). Yet, most studies investigating IVH volume use sophisticated and time-consuming volumetric analyses (15) that are impractical for routine clinical use and clinicians still lack a method for easily obtaining an estimate of the IVH volume. The purpose of this study was to create a useful tool for rapid determination of IVH volume and to further explore the prognostic significance of IVH volume. Specifically, we tried to assess the relationship between IVH volume or total volume (TV the combination of ICH and IVH volume) and clinical outcome. Conclusions-IVHS METHODS Study Design and PopulationA retrospective chart review of all patients admitted to our stroke center between April 2003 and June 2006 with the diagnosis of ICH. Patients were included if they suffered from spontaneous nontraumatic ICH and had evidence of IVH on computed tomography (CT) during admission done within 24 hours of onset. Patients were excluded from the analysis if they had ICH secondary to vascular malformations, tumor, or hemorrhagic conversion of an infarct. All CT scans were done using identical technique (slice thickness 5 mm, gantry tilt −16). We also excluded patient...

The Modified Graeb Score

“…28 This IVH score is a quick and easy assessment tool in which the user assesses the scan, and then uses a simple exponential equation to approximate the IVH volume in mL. It correlates well with measured IVH volume (R = 0.8), 28 but has not been validated using multiple longitudinal assessments nor has it been reduced to a form that is used in prospective clinical trials. Another assessment method, semiautomatic image segmentation, has been proposed for IVH measurement.…”

The benefit of prothrombin complex concentrate in decreasing neurological deterioration in patients with warfarin-associated intracerebral haemorrhage

“…13 Haematoma volume within the ventricular extension was estimated by using the intraventricular haemorrhage Infuse 2 units of FFP Check to see whether type and screen had been done before score. 14 The primary outcome measure was neurological deterioration, defined as ≥2-point decrease in GCS or limb power. This was selectively studied in patients with an initial GCS of more than 8, who were not intubated and who were not initially considered for surgery upon diagnosis of ICH, ie those who were initially selected for medical treatment (target group).…”

Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage

“…ICH volume was estimated with the ABC/2 method21 in 12 and with planimetric methods in 4 registries. IVH volume was estimated with planimetric methods (2 registries), Hallevi score22 (3 registries), or an estimate of the Hallevi score based on the Graeb score multiplied by 2 (6 registries). Immediate palliation was defined as the decision to withhold active treatment and to provide palliative care only immediately after ICH diagnosis.…”