UMEM Educational Pearls

Title: How Good are Emergency Physicians in Estimating ICH Volume?

Category: Neurology

Keywords: Intracerebral hemorrhage, ICH, volume, ABC/2 (PubMed Search)

Posted: 1/9/2019 by WanTsu Wendy Chang, MD
Click here to contact WanTsu Wendy Chang, MD

Intracerebral hemorrhage (ICH) volume is a predictor of mortality and clinical outcome.
Communicating ICH volume to neurosurgical and neurocritical care consultants can help direct treatment decisions.
ICH volume can be estimated using the ABC/2 formula:
- Select the CT slice with the largest area of the hemorrhage (reference slice)
- A = Measure the largest diameter
- B = Measure the largest diameter perpendicular to A
- C = Multiply the number of CT slices with the hemorrhage by the slice thickness
  - Slices with 25-75% of the hematoma volume compared to the reference slice count as 1/2 slice
  - Slices with <25% of the hematoma volume compared to the reference slice do not count

A recent study by Dsouza et al. found that EM attendings as well as EM trainees were reliable in estimating ICH volume using ABC/2 compared to radiologists.

Bottom Line: EPs can reliably estimate ICH volume using the ABC/2 formula. Communicating ICH volume to neurosurgical and neurocritical care consultants can help direct treatment decisions.

References

Dsouza LB, Pathan SA, Bhutta ZA, et al. ABC/2 estimation in intracerebral hemorrhage: A comparison study between emergency radiologists and emergency physicians. Am J Emerg Med. 2018 Dec 19. [Epub ahead of print]

Follow me on Twitter @EM_NCC