Predicting Intracerebral Hemorrhage Expansion With Noncontrast Computed Tomography: The BAT Score

• Published in: Stroke (1970) Vol. 49; no. 5; pp. 1163 - 1169
• Main Authors: Morotti, Andrea, Dowlatshahi, Dar, Boulouis, Gregoire, Al-Ajlan, Fahad, Demchuk, Andrew M., Aviv, Richard I., Yu, Liyang, Schwab, Kristin, Romero, Javier M., Gurol, M. Edip, Viswanathan, Anand, Anderson, Christopher D., Chang, Yuchiao, Greenberg, Steven M., Qureshi, Adnan I., Rosand, Jonathan, Goldstein, Joshua N.
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01.05.2018
• Subjects: cerebral hemorrhage; hematoma; biomarkers; angiography; sensitivity and specificity
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.117.020138

BACKGROUND AND PURPOSE—Although the computed tomographic angiography spot sign performs well as a biomarker for hematoma expansion (HE), computed tomographic angiography is not routinely performed in the emergency setting. We developed and validated a score to predict HE-based on noncontrast computed tomography (NCCT) findings in spontaneous acute intracerebral hemorrhage. METHODS—After developing the score in a single-center cohort of patients with intracerebral hemorrhage (n=344), we validated it in a large clinical trial population (n=954) and in a multicenter intracerebral hemorrhage cohort (n=241). The following NCCT markers of HE were analyzedhypodensities, blend sign, hematoma shape and density, and fluid level. HE was defined as hematoma growth >6 mL or >33%. The score was created using the estimates from multivariable logistic regression after final predictors were selected from bootstrap samples. RESULTS—Presence of blend sign (odds ratio, 3.09; 95% confidence interval [CI],1.49–6.40; P=0.002), any intrahematoma hypodensity (odds ratio, 4.54; 95% CI, 2.44–8.43; P<0.0001), and time from onset to NCCT <2.5 hours (odds ratio, 3.73; 95% CI, 1.86–7.51; P=0.0002) were predictors of HE. A 5-point score was created (BAT score1 point for blend sign, 2 points for any hypodensity, and 2 points for timing of NCCT <2.5 hours). The c statistic was 0.77 (95% CI, 0.70–0.83) in the development population, 0.65 (95% CI 0.61–0.68) and 0.70 (95% CI, 0.64–0.77) in the 2 validation cohorts. A dichotomized score (BAT score ≥3) predicted HE with 0.50 sensitivity and 0.89 specificity. CONCLUSIONS—An easy to use 5-point prediction score can identify subjects at high risk of HE with good specificity and accuracy. This tool requires just a baseline NCCT scan and may help select patients with intracerebral hemorrhage for antiexpansion clinical trials.