title: External validation of the secondary intracerebral hemorrhage score in The Netherlands.
abstract: OBJECTIVE
  We aimed to validate externally in a setting outside the United States the secondary intracerebral hemorrhage (ICH) score that was developed to predict the probability of macrovascular causes in patients with nontraumatic ICH.
  
  
  METHODS
  Patients with nontraumatic ICH admitted to the University Medical Center Utrecht, the Netherlands, between 2003 and 2011 were included if an angiographic examination, neurosurgical inspection, or pathological examination had been performed. Secondary ICH score performance was assessed by calibration (agreement between predicted and observed outcomes) and discrimination (separation of those with and without macrovascular cause).
  
  
  RESULTS
  Forty-eight of 204 patients (23.5%) had a macrovascular cause. The secondary ICH score showed modest calibration (P=0.06) and modest discriminative ability (c-statistic 0.73; 95% confidence interval, 0.65-0.80). Discrimination improved slightly using only noncontrast computed tomography categorization (c-statistic 0.79; 95% confidence interval, 0.72-0.86).
  
  
  CONCLUSIONS
  The discriminative ability and calibration of the secondary ICH score are moderate in a university hospital setting outside the United States. Clues on noncontrast computed tomography are the strongest predictor of a macrovascular cause in patients with ICH.
authors.affiliation: From the Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (C.J.J.v.A., G.J.E.R., A.A., C.J.M.K.), Department of Radiology (B.K.V.), Julius Center for Health Sciences and Primary Care (J.P.G., A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands (P.J.v.L.).
authors.forename: Charlotte J J
authors.initials: CJ
authors.lastname: van Asch
authors.forename: Birgitta K
authors.initials: BK
authors.lastname: Velthuis
authors.forename: Jacoba P
authors.initials: JP
authors.lastname: Greving
authors.forename: Peter Jan
authors.initials: PJ
authors.lastname: van Laar
authors.forename: Gabriël J E
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Catharina J M
authors.initials: CJ
authors.lastname: Klijn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
keywords: angiography; arteriovenous malformation; cerebral hemorrhage