title: A practical prediction model for early hematoma expansion in spontaneous deep ganglionic intracerebral hemorrhage.
abstract: OBJECTIVE
  Early hematoma expansion is a known cause of morbidity and mortality in patients with intracerebral hemorrhage (ICH). The goal of this study was to identify clinical predictors of ICH growth in the acute stage.
  
  
  METHODS
  We studied 201 patients with acute (<6 h) deep ganglionic ICH. Patients underwent CT scan at baseline and hematoma expansion (>33% or >12.5 ml increase) was determined on the second scan performed within 24 h. Fourteen clinical and neuroimaging variables (age, gender, GCS at admission, hypertension, diabetes mellitus, kidney disease, stroke, hemorrhagic, antiplatelet use, anticoagulant use, hematoma density heterogeneity, hematoma shape irregularity, hematoma volume and presence of IVH) were registered. Additionally, blood pressure was registered at initial systolic BP (i-SBP) and systolic BP 1.5 h after admission (1.5 h-SBP). The discriminant value of the hematoma volume and 1.5 h-SBP for hematoma expansion were determined by the receiver operating characteristic (ROC) curves. Factors associated with hematoma expansion were analyzed with multiple logistic regression.
  
  
  RESULTS
  Early hematoma expansion occurred in 15 patients (7.0%). The cut-off value of hematoma volume and 1.5 h-SBP were determined to be 16 ml and 160 mmHg, respectively. Hematoma volume above 16 ml (HV>16) ([OR]=5.05, 95% CI 1.32-21.36, p=0.018), hematoma heterogeneity (HH) ([OR]=7.81, 95% CI 1.91-40.23, p=0.004) and 1.5 h-SBP above 160 mmHg (1.5 h-SBP>160) ([OR]=8.77, 95% CI 2.33-44.56, p=0.001) independently predicted ICH expansion. If those three factors were present, the probability was estimated to be 59%.
  
  
  CONCLUSIONS
  The presented model (HV>16, HH, 1.5 h-SBP>160) can be a practical tool for prediction of ICH growth in the acute stage. Further prospective studies are warranted to validate the ability of this model to predict clinical outcome.
authors.affiliation: Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan. ririkotakeda@yahoo.co.jp
authors.forename: Ririko
authors.initials: R
authors.lastname: Takeda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ogura
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Ooigawa
authors.forename: Goji
authors.initials: G
authors.lastname: Fushihara
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Yoshikawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Okada
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Araki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kurita
mesh_terms: D000368:Aged; D000465:Algorithms; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D020145:Basal Ganglia Hemorrhage / Q000209:etiology* / Q000473:pathology*; D001794:Blood Pressure / Q000502:physiology; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000473:pathology*; D003627:Data Interpretation, Statistical; D018450:Disease Progression; D005260:Female; D005544:Forecasting; D015600:Glasgow Coma Scale; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D012372:ROC Curve; D014057:Tomography, X-Ray Computed
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers