title: The spot sign score in primary intracerebral hemorrhage identifies patients at highest risk of in-hospital mortality and poor outcome among survivors.
abstract: OBJECTIVE
  The spot sign score is a potent predictor of hematoma expansion in patients with primary intracerebral hemorrhage (ICH). We aim to determine the accuracy of this scoring system for the prediction of in-hospital mortality and poor outcome among survivors in patients with primary ICH.
  
  
  METHODS
  Three neuroradiologists retrospectively reviewed CT angiograms (CTAs) performed in 573 consecutive patients who presented to our Emergency Department with primary ICH over a 9-year period to determine the presence and scoring of spot signs according to strict criteria. Baseline ICH and intraventricular hemorrhage volumes were independently determined by computer-assisted volumetric analysis. Medical records were independently reviewed for baseline clinical characteristics and modified Rankin Scale (mRS) at hospital discharge and 3-month follow-up. Poor outcome among survivors was defined as a mRS > or =4 at 3-month follow-up.
  
  
  RESULTS
  We identified spot signs in 133 of 573 CTAs (23.2%), 11 of which were delayed spot signs (8.3%). The presence of any spot sign increased the risk of in-hospital mortality (55.6%, OR 4.0, 95% CI 2.6 to 5.9, P<0.0001) and poor outcome among survivors at 3-month follow-up (50.8%, OR 2.5, 95% CI 1.4 to 4.3, P<0.0014). The spot sign score successfully predicted an escalating risk of both outcome measures. In multivariate analysis, the spot sign score was an independent predictor of in-hospital mortality (OR 1.5, 95% CI 1.2 to 1.9, P<0.0002) and poor outcome among survivors at 3-month follow-up (OR 1.6, 95% CI 1.1 to 2.1, P<0.0065).
  
  
  CONCLUSIONS
  The spot sign score is an independent predictor of in-hospital mortality and poor outcome among survivors in primary ICH.
authors.affiliation: Division of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, 510 S Kingshighway Blvd, Saint Louis, MO 63110, USA. delgadoj@mir.wustl.edu
authors.forename: Josser E
authors.initials: JE
authors.lastname: Delgado Almandoz
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stone
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Schaefer
authors.forename: Alexandra
authors.initials: A
authors.lastname: Oleinik
authors.forename: H Bart
authors.initials: HB
authors.lastname: Brouwers
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.forename: Michael H
authors.initials: MH
authors.lastname: Lev
authors.forename: R Gilberto
authors.initials: RG
authors.lastname: Gonzalez
authors.forename: Javier M
authors.initials: JM
authors.lastname: Romero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000401:mortality* / Q000473:pathology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012107:Research Design / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult