Predicting Hematoma Expansion After Primary Intracerebral Hemorrhage

作者：Hens Bart Brouwers, Yuchiao Chang, Guido J. Falcone, Xuemei Cai, Alison M. Ayres, Thomas W.K. Battey, Anastasia Vashkevich, Kristen A. McNamara, Valerie Valant, Kristin M. Schwab, Susannah C. Orzell, Linda Marie Bresette, Steven K. Feske, Natalia S. Rost, Javier M. Romero, Anand Viswanathan, Sherry Chou, Steven Mark Greenberg, Jonathan M. Rosand, Joshua Norkin Goldstein · 发表于：JAMA Neurology · 年份：2013 · DOI：10.1001/jamaneurol.2013.5433 · 被引用次数：368 · 研究领域：Intracerebral and Subarachnoid Hemorrhage Research、Acute Ischemic Stroke Management、Traumatic Brain Injury and Neurovascular Disturbances

IMPORTANCE: Many clinical trials focus on restricting hematoma expansion following acute intracerebral hemorrhage (ICH), but selecting those patients at highest risk of hematoma expansion is challenging. OBJECTIVE: To develop a prediction score for hematoma expansion in patients with primary ICH. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study at 2 urban academic medical centers among patients having primary ICH with available baseline and follow-up computed tomography for volumetric analysis (817 patients in the development cohort and 195 patients in the independent validation cohort). MAIN OUTCOMES AND MEASURES: Hematoma expansion was assessed using semiautomated software and was defined as more than 6 mL or 33% growth. Covariates were tested for association with hematoma expansion using univariate and multivariable logistic regression. A 9-point prediction score was derived based on the regression estimates and was subsequently tested in the independent validation cohort. RESULTS: Hematoma expansion occurred in 156 patients (19.1%). In multivariable analysis, predictors of expansion were as follows: warfarin sodium use, the computed tomography angiography spot sign, and shorter time to computed tomography (≤ 6 vs >6 hours) (P < .001 for all), as well as baseline ICH volume (<30 [reference], 30-60 [P = .03], and >60 [P = .005] mL). The incidence of hematoma expansion steadily increased with higher scores. In the independent validation cohort (n = 195), our predi...