Hematoma Shape, Hematoma Size, Glasgow Coma Scale Score and ICH Score: Which Predicts the 30-Day Mortality Better for Intracerebral Hematoma?

Abstract

PurposeTo investigate the performance of hematoma shape, hematoma size, Glasgow coma scale (GCS) score, and intracerebral hematoma (ICH) score in predicting the 30-day mortality for ICH patients. To examine the influence of the estimation error of hematoma size on the prediction of 30-day mortality.Materials and MethodsThis retrospective study, approved by a local institutional review board with written informed consent waived, recruited 106 patients diagnosed as ICH by non-enhanced computed tomography study. The hemorrhagic shape, hematoma size measured by computer-assisted volumetric analysis (CAVA) and estimated by ABC/2 formula, ICH score and GCS score was examined. The predicting performance of 30-day mortality of the aforementioned variables was evaluated. Statistical analysis was performed using Kolmogorov-Smirnov tests, paired t test, nonparametric test, linear regression analysis, and binary logistic regression. The receiver operating characteristics curves were plotted and areas under curve (AUC) were calculated for 30-day mortality. A P value less than 0.05 was considered as statistically significant.ResultsThe overall 30-day mortality rate was 15.1% of ICH patients. The hematoma shape, hematoma size, ICH score, and GCS score all significantly predict the 30-day mortality for ICH patients, with an AUC of 0.692 (P = 0.0018), 0.715 (P = 0.0008) (by ABC/2) to 0.738 (P = 0.0002) (by CAVA), 0.877 (P<0.0001) (by ABC/2) to 0.882 (P<0.0001) (by CAVA), and 0.912 (P<0.0001), respectively.ConclusionOur study shows that hematoma shape, hematoma size, ICH scores and GCS score all significantly predict the 30-day mortality in an increasing order of AUC. The effect of overestimation of hematoma size by ABC/2 formula in predicting the 30-day mortality could be remedied by using ICH score.

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

“…Especially, those hematomas were particularly exposed to inaccurate ABC/2 measurements, however, which implies significant volume bias within the surgical cohort. 16,[22][23][24] Regarding our hypothesis, this finding raises the possibility that inaccuracy of ABC/2 is a contributor to inconclusive results regarding surgical outcome after ICH. Moreover, it illustrates why it is of clinical interest to improve methods of ICH quantification to allow for a careful reevaluation of ICH volume as an outcome surrogate.…”

“…13,15,16,22,23 Direct comparison of algorithm and ABC/2 measurements ( Figure 2C) suggests independent errors affecting each respective method because any mutual error-causing disagreement from manual segmentations would be cancelled out in a Bland-Altman comparison. Although error is primarily driven by size, shape, and location in ABC/2, we identified increased misclassification in hematomas exhibiting multiple clot stages and inhomogeneous density in the segmentation algorithm.…”

The accuracy and precision of CT scan diagnosis in comparison with surgical findings in distinguishing epidertal hematoma from subdural hematoma

“…Another criterion used to diagnose and differentiate heptate dopamine hematoma from subdural hematoma is the shape of the lesion, the analysis of the results of which shows higher efficiency of Ct scan findings in differentiating these two types of hematomas. According to Chi Wuong et al study, which was conducted to provide appropriate criterion for 30-day prediction of mortality for intracranial hemorrhage, the accuracy rate of prediction turned out to be 70%; they stated that the shape of the lesion does not function as a sufficiently effective criterion in predicting the patient's fate and intracranial hemorrhage (14). Another criterion used for CT scan images to detect and distinguish between these two hematomas is the presence or absence of fractures.…”

“…In a similar study conducted by Ghafouri et al, it was stated that the calculated sensitivity of CT scan, in terms of the extent of hematoma, was 95.7% for epitural hematoma and 80% for subdural hematoma (3). Based on the findings of Chi Wang et al study, which used CAVA and ABC/2 methods in order to determine CT scan sensitivity in the measurement of hematoma size as predictors of the fate of patients with traumatic brain injury, CAVA turned out to have a sensitivity rate of 71.5% and ABC/2 a sensitivity rate of 73.8% (14). CT scan has a high diagnostic power to differentiate these two hematomas and is a very suitable way to examine and predict the fate of patients with traumatic brain injury (1).…”

Comparison of Post-Stroke Functional Recovery between Ischemic and Hemorrhagic Stroke Patients: A Prospective Cohort Study

“…In ischemic stroke, necrotic neuron persists despite the reperfusion that occurs, but, in hemorrhagic stroke, after blood is drained and intracranial pressure is relieved, neurons may recover.2 Therefore, prognosis of hemorrhagic stroke patients is largely influenced by duration of bleeding and size of hematoma. 7,10,11 Although hemorrhagic stroke has higher mortality and worse functional outcome than ischemic stroke, [3][4][5] hemorrhagic stroke patients who survive have better functional improvement than ischemic stroke. [6][7][8] From the result of this study, hemorrhagic stroke patients tended to be more severe on admission, yet they improved faster and had better final CNS scores (Figure 1).…”