• Neurocritical care · Jun 2020

    Comparative Study

    Validation and Comparison of Noncontrast CT Scores to Predict Intracerebral Hemorrhage Expansion.

    • Loris Poli, Eleonora Leuci, Paolo Costa, Valeria De Giuli, Filomena Caria, Elisa Candeloro, Alessandra Persico, Massimo Gamba, Mauro Magoni, Giuseppe Micieli, Anna Cavallini, Alessandro Padovani, Alessandro Pezzini, and Andrea Morotti.
    • Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy. loris.poli@gmail.com.
    • Neurocrit Care. 2020 Jun 1; 32 (3): 804-811.

    Background And PurposeThe BAT, BRAIN, and HEP scores have been proposed to predict hematoma expansion (HE) with noncontrast computed tomography (NCCT). We sought to validate these tools and compare their diagnostic performance.MethodsWe retrospectively analyzed two cohorts of patients with primary intracerebral hemorrhage. HE expansion was defined as volume growth > 33% or > 6 mL. Two raters analyzed NCCT scans and calculated the scores, blinded to clinical and imaging data. The inter-rater reliability was assessed with the interclass correlation statistic. Discrimination and calibration were calculated with area under the curve (AUC) and Hosmer-Lemeshow χ2 statistic, respectively. AUC comparison between different scores was explored with DeLong test. We also calculated the sensitivity, specificity, positive, and negative predictive values of the dichotomized scores with cutoffs identified with the Youden's index.ResultsA total of 230 subjects were included, of whom 86 (37.4%) experienced HE. The observed AUC for HE were 0.696 for BAT, 0.700 for BRAIN, and 0.648 for HEP. None of the scores had a significantly superior AUC compared with the others (all p > 0.4). All the scores had good calibration (all p > 0.3) and good-to-excellent inter-rater reliability (interclass correlation > 0.8). BAT ≥ 3 showed the highest specificity (0.81), whereas BRAIN ≥ 6 had the highest sensitivity (0.76).ConclusionsThe BAT, BRAIN, and HEP scores can predict HE with acceptable discrimination and require just a baseline NCCT scan. These tools may be used to stratify the risk of HE in clinical practice or randomized controlled trials.

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