Clinical Prediction Algorithm (BRAIN) to Determine Risk of Hematoma Growth in Acute Intracerebral Hemorrhage

Wang, Xia; Arima, Hisatomi; Salman, Rustam Al-Shahi; Woodward, Mark; Heeley, Emma; Stapf, Christian; Lavados, Pablo M.; Robinson, Thompson G.; Huang, Yining; Wang, Ji‐Guang; Delcourt, Candice; Anderson, Craig S.

doi:10.1161/strokeaha.114.006910

Cited by 100 publications

(74 citation statements)

References 31 publications

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“…However, the hemorrhage also induces a series of biochemical events that include activation of the coagulation cascade, formation of hemoglobin breakdown products, oxidative stress, inflammation and blood-brain barrier permeability, and all of them contribute to the formation of perihematomal edema and secondary injury (11). The edema then can increase the intracranial pressure (ICP) and thus induce additional brain injury in the surrounding parenchyma (16). It is widely known that the supratentorial ICH is commonly accompanied by headache and vomiting as a result of the increased intracranial pressure and meningismus caused by the blood flow in the ventricles of the brain (17,18).…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcome in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage

Rendevski¹,

Stojanov²,

Aleksovski³

et al. 2017

Acta Facultatis Medicae Naissensis

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The aim of the paper was to evaluate the surgical outcome in patients with spontaneous supratentorial intracerebral hemorrhage (ICH) after surgical intervention, in respect to the initial clinical conditions, age, sex, hemispheric side and anatomic localization of ICH. Thirty-eight surgically treated patients with spontaneous supratentorial intracerebral hemorrhage were included in the study. The surgical outcome was evaluated three months after the initial admission, according to the Glasgow Outcome Scale (GOS). The surgical treatment was successful in 14 patients (37%), whereas it was unsuccessful in 24 patients (63%). We have detected a significant negative correlation between the Glasgow Coma Scale (GCS) scores on admission and the GOS scores after three months, suggesting worse neurological outcome in patients with initially lower GCS scores. The surgical outcome in patients with ICH was not affected by the sex, the hemispheric side and the anatomic localization of ICH, but the age of the patients was estimated as a significant factor for their functional outcome, with younger patients being more likely to be treated successfully. The surgical outcome is affected from the initial clinical state of the patients and their age. The treatment of ICH is still an unsolved clinical problem and the development of new surgical techniques with larger efficiency in the evacuation of the hematoma is necessary, thus making a minimal damage to the normal brain tissue, as well as decreasing the possibility of postoperative bleeding.

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Section: Discussionmentioning

confidence: 99%

Surgical Outcome in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage

Rendevski¹,

Stojanov²,

Aleksovski³

et al. 2017

Acta Facultatis Medicae Naissensis

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“…3,8 For the 24-point BRAIN prediction score validation, a >6 mL definition was used. 7 A >6 and ≥12.5 mL definition 3 of HE was also explored for all scores. Discrimination of the HE scores was assessed using receiver operating characteristic curves and area under the curve (AUC).…”

Section: Discussionmentioning

confidence: 99%

“…6 Independently, a 24-point clinical score (BRAIN) was derived and validated for HE (>6 mL) from substudies of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1 and 2). 7 Score items were similar but included recurrent ICH and intraventricular hemorrhage extension. The 24-point score demonstrated acceptable discrimination but was limited by lack of baseline CTA and spot sign designation; the most robust predictor of expansion to date.…”

Section: Strokementioning

confidence: 99%

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

Huynh

Aviv

Dowlatshahi

et al. 2015

Stroke

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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.

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“…The role of surgery in the treatment of ICH still remains inconclusive, despite recent large randomized trials, however. [3][4][5][6][7][8][9] Part of the controversy about the value of surgical interventions might be explained by the fact that hematoma volume, a key prognostic factor of interest, has rarely been measured in precise volumetric fashion in surgical outcome studies. [10][11][12][13][14] Instead, clot volume is commonly estimated by the formula ABC/2 until today, owing to the unparalleled applicability and time efficiency of this method.…”

mentioning

confidence: 99%

Development and Validation of an Automatic Segmentation Algorithm for Quantification of Intracerebral Hemorrhage

Scherer

Cordes

Younsi

et al. 2016

Stroke

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Background and Purpose-ABC/2 is still widely accepted for volume estimations in spontaneous intracerebral hemorrhage (ICH) despite known limitations, which potentially accounts for controversial outcome-study results. The aim of this study was to establish and validate an automatic segmentation algorithm, allowing for quick and accurate quantification of ICH. Methods-A segmentation algorithm implementing first-and second-order statistics, texture, and threshold features was trained on manual segmentations with a random-forest methodology. Quantitative data of the algorithm, manual segmentations, and ABC/2 were evaluated for agreement in a study sample (n=28) and validated in an independent sample not used for algorithm training (n=30). Results-ABC/2 volumes were significantly larger compared with either manual or algorithm values, whereas no significant differences were found between the latter (P<0.0001; Friedman+Dunn's multiple comparison

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Clinical Prediction Algorithm (BRAIN) to Determine Risk of Hematoma Growth in Acute Intracerebral Hemorrhage

Cited by 100 publications

References 31 publications

Surgical Outcome in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage

Surgical Outcome in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage

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

Development and Validation of an Automatic Segmentation Algorithm for Quantification of Intracerebral Hemorrhage

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