title: Ultraearly hematoma growth predicts poor outcome after acute intracerebral hemorrhage.
abstract: OBJECTIVE
  To investigate the impact of the adjustment of initial intracerebral hemorrhage (ICH) volume by onset-to-imaging time (ultraearly hematoma growth [uHG]) on further hematoma enlargement and outcome in patients with acute ICH.
  
  
  METHODS
  We studied 133 patients with acute (<6 hours) supratentorial ICH. Patients underwent baseline and 24-hour CT scans for ICH volume measurement, and a CT angiography (CTA) for the detection of the spot sign. We defined uHG as the relation between baseline ICH volume/onset-to-imaging time, hematoma growth (HG) as hematoma enlargement >33% or >6 mL at 24 hours, early neurologic deterioration (END) as increase ≥4 points in the NIH Stroke Scale score or death at 24 hours, and poor long-term outcome as modified Rankin Scale score >2 at 3 months.
  
  
  RESULTS
  The uHG was significantly faster in spot sign patients (p < 0.001), as well as in patients who experienced HG (p = 0.021), END (p < 0.001), 3-month mortality (p < 0.001), and poor long-term outcome (p < 0.001). The uHG improved the accuracy of baseline ICH volume in the prediction of END (sensitivity 93.1% vs 82.8%, specificity 85.3% vs 82.4%) and 3-month mortality (sensitivity 77.5% vs 70%, specificity 87.9% vs 84.6%). A uHG >10.2 mL/hour emerged as the most powerful predictor of HG (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.39-9.07, p = 0.008), END (OR 70.22, 95% CI 14.63-337.03, p < 0.001), 3-month mortality (OR 16.96, 95% CI 5.32-54.03, p < 0.001), and poor long-term outcome (OR 6.19, 95% CI 1.32-28.98, p = 0.021).
  
  
  CONCLUSIONS
  The uHG represents a powerful and easy-to-use tool for improving the prediction of HG and outcome in patients with acute ICH.
authors: Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: D
authors: D
authors: Rodriguez-Luna
authors: M
authors: M
authors: Rubiera
authors: M
authors: M
authors: Ribo
authors: P
authors: P
authors: Coscojuela
authors: S
authors: S
authors: Piñeiro
authors: J
authors: J
authors: Pagola
authors: M
authors: M
authors: Hernandez-Guillamon
authors: B
authors: B
authors: Ibarra
authors: F
authors: F
authors: Romero
authors: J
authors: J
authors: Alvarez-Sabin
authors: J
authors: J
authors: Montaner
authors: C A
authors: CA
authors: Molina
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000150:complications*; D018450:Disease Progression; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D014057:Tomography, X-Ray Computed / Q000379:methods