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  • Title: Predicting Intracerebral Hemorrhage Expansion With Noncontrast Computed Tomography: The BAT Score.
    Author: Morotti A, Dowlatshahi D, Boulouis G, Al-Ajlan F, Demchuk AM, Aviv RI, Yu L, Schwab K, Romero JM, Gurol ME, Viswanathan A, Anderson CD, Chang Y, Greenberg SM, Qureshi AI, Rosand J, Goldstein JN, ATACH-II, NETT, and PREDICT Investigators.
    Journal: Stroke; 2018 May; 49(5):1163-1169. PubMed ID: 29669875.
    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 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. 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 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. 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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