title: The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications.
abstract: OBJECTIVE
  Intraventricular extension of intracerebral hemorrhage (IVH) is an independent predictor of poor outcome. IVH volume may be important in outcome prediction and management; however, it is difficult to measure routinely.
  
  
  METHODS
  We reviewed the charts and computed tomographies of a cohort of consecutive patients with IVH. The cohort was divided into two groups: index and validation by random sampling. IVH and intracerebral hemorrhage (ICH) volume were measured manually in all patients. IVH was also graded using a simple classification system termed IVH score (IVHS). Clinical outcome was determined by the modified Rankin Scale (mRS) at discharge and in-hospital death. Poor outcome was defined as mRS 4-6.
  
  
  RESULTS
  One hundred seventy-five patients were analyzed, 92 in the index group and 83 in the validation group. Exponential regression yielded the following formula for estimating IVH volume (mL): eIVHS/5 (R = .75, p < 0.001). The IVH estimation formula was then verified in the validation group (R = .8, p < 0.001). The following correlations with mRS were obtained: IVH volume R = .305; ICH volume R = .468; total volume [TV] R = .571 (p < 0.001 for all three correlations). Partial correlation of TV with mRS controlling for ICH volume yielded R = .3 for TV (p < 0.001). Logistic regression model comparing ICH and TV association with poor outcome yielded the following: ICH odds ratio = 5.2, 95% confidence interval 2.3-11.6, p < 0.001; TV odds ratio = 41.6, 95% confidence interval 9.6-180.6, p < 0.001. Substituting TV for ICH volume in the ICH score resulted in a significant increase in the specificity from 64% to 87% for predicting mortality.
  
  
  CONCLUSIONS
  IVHS enables clinicians to rapidly estimate IVH volume. The addition of IVH to ICH volume increases its predictive power for poor outcome and mortality significantly. IVHS and TV may be used in clinical practice and clinical trials of patients with ICH.
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA. hen.hallevi@gmail.com
authors.forename: Hen
authors.initials: H
authors.lastname: Hallevi
authors.forename: Nabeel S
authors.initials: NS
authors.lastname: Dar
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Barreto
authors.forename: Miriam M
authors.initials: MM
authors.lastname: Morales
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
authors.forename: Anitha T
authors.initials: AT
authors.lastname: Abraham
authors.forename: Kyle C
authors.initials: KC
authors.lastname: Walker
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Gonzales
authors.forename: Kachikwu
authors.initials: K
authors.lastname: Illoh
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
authors.forename: Sean I
authors.initials: SI
authors.lastname: Savitz
mesh_terms: D002543:Cerebral Hemorrhage / Q000473:pathology*; D002552:Cerebral Ventricles; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index