Validation of the 9-Point and 24-Point Hematoma Expansion Prediction Scores and Derivation of the PREDICT A/B Scores

Abstract

Background and Purpose-Nine-and 24-point prediction scores have recently been published to predict hematoma expansion (HE) in acute intracerebral hemorrhage. We sought to validate these scores and perform an independent analysis of HE predictors. Methods-We retrospectively studied 301 primary or anticoagulation-associated intracerebral hemorrhage patients presenting <6 hours post ictus prospectively enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus Computed Tomography (PREDICT) study. Patients underwent baseline computed tomography angiography and 24-hour noncontrast computed tomography follow-up for HE analysis. Discrimination and calibration of the 9-and 24-point scores was assessed. Independent predictors of HE were identified using multivariable regression and incorporated into the PREDICT A/B scores, which were then compared with existing scores. Results-The 9-and 24-point HE scores demonstrated acceptable discrimination for HE>6 mL or 33% and >6 mL, respectively (area under the curve of 0.706 and 0.755, respectively). The 24-point score demonstrated appropriate calibration in the PREDICT cohort (χ 2 statistic, 11.5; P=0.175), whereas the 9-point score demonstrated poor calibration (χ 2 statistic, 34.3; P<0.001). Independent HE predictors included spot sign number, time from onset, warfarin use or international normalized ratio >1.5, Glasgow Coma Scale, and National Institutes of Health Stroke Scale and were included in PREDICT A/B scores. PREDICT A showed improved discrimination compared with both existing scores, whereas performance of PREDICT B varied by definition of expansion. Conclusions-The 9-and 24-point expansion scores demonstrate acceptable discrimination in an independent multicenter cohort; however, calibration was suboptimal for the 9-point score. The PREDICT A score showed improved discrimination for HE prediction but requires independent validation.

A reliable grading system for prediction of hematoma expansion in intracerebral hemorrhage in the basal ganglia

“…IVH extension and anticoagulant use are also associated with HE according to several previous studies (11)(12)(13)(14)(15). Moreover, these two variables had been identified as significant predictors of HE in previous studies (4,19,20). In the current study, these two risk factors were highly associated with HE (both P < 0.001).…”

“…In 2015, Wang et al (21) refined the 9-point score by including baseline ICH volume (≤ 10 mL,10-20 mL or > 20 mL) and the time to the initial CT (≤ 1 h, 1-2 h, 2-3 h, 3-4 h, 4-5 h and > 5 h). Based on the 9-point score, Wang et al (19) proposed a new 24-point score (BRAIN) and they added two novel parameters: IVH extension and recurrent ICH. The scores from that system are similar to those in previous studies.…”

Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data

“…Interest has grown in whether a so-called spot sign due to contrast extravasation on additional angiography at the time of diagnostic imaging is a predictor of intracerebral haemorrhage growth 6 . There are several multivariable prediction models for intracerebral haemorrhage growth,7, 8, 9, 10, 11 but the identified predictors have varied across models, and several have relied on CT angiography, 12 which is not readily available in low-income and middle-income countries. Identifying more accurate predictors of intracerebral haemorrhage growth is recognised to be a research priority 13 …”

Leukocyte Count and Intracerebral Hemorrhage Expansion

“…Hematoma expansion occurs in the first hours following an ICH and therefore early identification of patients with the highest risk of expansion is necessary. Current hematoma expansion predictive models are mainly based on clinical and imaging markers (17,41,42). Neutrophil and monocyte counts are cheap, fast and widely available biomarkers that might improve our ability to stratify the risk of hematoma expansion in clinical practice.…”