Predicting Intracerebral Hemorrhage Expansion With Noncontrast Computed Tomography: The BAT Score
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 compute...
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| Published in | Stroke (1970) Vol. 49; no. 5; pp. 1163 - 1169 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
American Heart Association, Inc
01.05.2018
|
| Subjects | |
| Online Access | Get full text |
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| Abstract | 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. |
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| AbstractList | 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.
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 analyzed: hypodensities, 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.
Presence of blend sign (odds ratio, 3.09; 95% confidence interval [CI],1.49-6.40;
=0.002), any intrahematoma hypodensity (odds ratio, 4.54; 95% CI, 2.44-8.43;
<0.0001), and time from onset to NCCT <2.5 hours (odds ratio, 3.73; 95% CI, 1.86-7.51;
=0.0002) were predictors of HE. A 5-point score was created (BAT score: 1 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.
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. 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. 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.BACKGROUND AND PURPOSEAlthough 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.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 analyzed: hypodensities, 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.METHODSAfter 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 analyzed: hypodensities, 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.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 score: 1 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.RESULTSPresence 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 score: 1 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.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.CONCLUSIONSAn 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. |
| Author | Gurol, M. Edip Qureshi, Adnan I. Goldstein, Joshua N. Boulouis, Gregoire Rosand, Jonathan Chang, Yuchiao Schwab, Kristin Demchuk, Andrew M. Viswanathan, Anand Greenberg, Steven M. Al-Ajlan, Fahad Aviv, Richard I. Morotti, Andrea Yu, Liyang Dowlatshahi, Dar Anderson, Christopher D. Romero, Javier M. |
| AuthorAffiliation | From the Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy (A.M.); Department of Medicine (Neurology), University of Ottawa, Ottawa Hospital Research Institute, Canada (D.D., F.A.-A.) Department of Neuroradiology, Université Paris Descartes, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, France (G.B.) Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Canada (A.M.D.) Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Canada (R.I.A.) Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (L.Y., Y.C.) J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.M.R., K.S., M.E.G., A.V., C.D.A., S.M.G., J.R., J.N.G.) Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.D.A., J.R. |
| AuthorAffiliation_xml | – name: From the Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy (A.M.); Department of Medicine (Neurology), University of Ottawa, Ottawa Hospital Research Institute, Canada (D.D., F.A.-A.) Department of Neuroradiology, Université Paris Descartes, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, France (G.B.) Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Canada (A.M.D.) Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Canada (R.I.A.) Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (L.Y., Y.C.) J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.M.R., K.S., M.E.G., A.V., C.D.A., S.M.G., J.R., J.N.G.) Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.D.A., J.R., J.N.G.) Neuroradiology Service, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.M.R.) Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.N.G.) Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis (A.I.Q.) |
| Author_xml | – sequence: 1 givenname: Andrea surname: Morotti fullname: Morotti, Andrea organization: From the Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy (A.M.); Department of Medicine (Neurology), University of Ottawa, Ottawa Hospital Research Institute, Canada (D.D., F.A.-A.) Department of Neuroradiology, Université Paris Descartes, INSERM S894, DHU Neurovasc, Centre Hospitalier Sainte-Anne, France (G.B.) Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Canada (A.M.D.) Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Canada (R.I.A.) Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (L.Y., Y.C.) J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.M.R., K.S., M.E.G., A.V., C.D.A., S.M.G., J.R., J.N.G.) Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (C.D.A., J.R., J.N.G.) Neuroradiology Service, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.M.R.) Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.N.G.) Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis (A.I.Q.) – sequence: 2 givenname: Dar surname: Dowlatshahi fullname: Dowlatshahi, Dar – sequence: 3 givenname: Gregoire surname: Boulouis fullname: Boulouis, Gregoire – sequence: 4 givenname: Fahad surname: Al-Ajlan fullname: Al-Ajlan, Fahad – sequence: 5 givenname: Andrew surname: Demchuk middlename: M. fullname: Demchuk, Andrew M. – sequence: 6 givenname: Richard surname: Aviv middlename: I. fullname: Aviv, Richard I. – sequence: 7 givenname: Liyang surname: Yu fullname: Yu, Liyang – sequence: 8 givenname: Kristin surname: Schwab fullname: Schwab, Kristin – sequence: 9 givenname: Javier surname: Romero middlename: M. fullname: Romero, Javier M. – sequence: 10 givenname: M. surname: Gurol middlename: Edip fullname: Gurol, M. Edip – sequence: 11 givenname: Anand surname: Viswanathan fullname: Viswanathan, Anand – sequence: 12 givenname: Christopher surname: Anderson middlename: D. fullname: Anderson, Christopher D. – sequence: 13 givenname: Yuchiao surname: Chang fullname: Chang, Yuchiao – sequence: 14 givenname: Steven surname: Greenberg middlename: M. fullname: Greenberg, Steven M. – sequence: 15 givenname: Adnan surname: Qureshi middlename: I. fullname: Qureshi, Adnan I. – sequence: 16 givenname: Jonathan surname: Rosand fullname: Rosand, Jonathan – sequence: 17 givenname: Joshua surname: Goldstein middlename: N. fullname: Goldstein, Joshua N. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29669875$$D View this record in MEDLINE/PubMed |
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| PublicationTitle | Stroke (1970) |
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| Snippet | BACKGROUND AND PURPOSE—Although the computed tomographic angiography spot sign performs well as a biomarker for hematoma expansion (HE), computed tomographic... Although the computed tomographic angiography spot sign performs well as a biomarker for hematoma expansion (HE), computed tomographic angiography is not... |
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| Title | Predicting Intracerebral Hemorrhage Expansion With Noncontrast Computed Tomography: The BAT Score |
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