UMEM Educational Pearls

Category: Neurology

Title: Predicting ICH Expansion

Keywords: Intracerebral hemorrhage, ICH, hematoma expansion, prediction score, BAT score (PubMed Search)

Posted: 5/9/2018 by WanTsu Wendy Chang, MD (Updated: 5/27/2018)
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Takeaways

  • CT angiography (CTA) spot sign is a strong predictor of intracerebral hemorrhage (ICH) expansion.
  • However, since CTA is not part of the routine diagnostic workup of acute ICH, other predictors using noncontrast head CT have been reported in the past.
  • A 5-point BAT score can be used to identify patients at high risk of hematoma expansion:

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  • Patients with a score ≥ 3 have a higher risk of hematoma expansion

In-Depth

  • 14 Variables including patient age, sex, history of HTN, initial SBP and DBP, ICH volume at baseline, baseline INR, time from hemorrhage onset, and noncontrast head CT findings (hemorrhage location, hypodensities, blend sign, irregular shape, heterogeneous density, and fluid level) were analyzed by bivariate analysis and stepwise logistical regression using bootstrap samples.
  • AUC for the BAT score was 0.77 in the development sample, 0.65 and 0.70 in two validation cohorts.
  • Patients with coagulopathy were excluded in the development and validation of the BAT score to maximize the applicability of the score, though coagulopathy is a known predictor of hematoma expansion. 

References

Morotti A, Dowlatshahi D, Boulouis G, et al. Predicting intracerebral hemorrhage expansion with noncontrast computed tomography: The BAT score. Stroke 2018;49(5):1163-9. 

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