title: Predicting hematoma expansion after primary intracerebral hemorrhage.
abstract: OBJECTIVE
  Many clinical trials focus on restricting hematoma expansion following acute intracerebral hemorrhage (ICH), but selecting those patients at highest risk of hematoma expansion is challenging.
  
  
  OBJECTIVE
  To develop a prediction score for hematoma expansion in patients with primary ICH.
  
  
  METHODS
  Prospective cohort study at 2 urban academic medical centers among patients having primary ICH with available baseline and follow-up computed tomography for volumetric analysis (817 patients in the development cohort and 195 patients in the independent validation cohort).
  
  
  METHODS
  Hematoma expansion was assessed using semiautomated software and was defined as more than 6 mL or 33% growth. Covariates were tested for association with hematoma expansion using univariate and multivariable logistic regression. A 9-point prediction score was derived based on the regression estimates and was subsequently tested in the independent validation cohort.
  
  
  RESULTS
  Hematoma expansion occurred in 156 patients (19.1%). In multivariable analysis, predictors of expansion were as follows: warfarin sodium use, the computed tomography angiography spot sign, and shorter time to computed tomography (≤ 6 vs >6 hours) (P < .001 for all), as well as baseline ICH volume (<30 [reference], 30-60 [P = .03], and >60 [P = .005] mL). The incidence of hematoma expansion steadily increased with higher scores. In the independent validation cohort (n = 195), our prediction score performed well and showed strong association with hematoma expansion (odds ratio, 4.59; P < .001 for a high vs low score). The C statistics for the score were 0.72 for the development cohort and 0.77 for the independent validation cohort.
  
  
  CONCLUSIONS
  A 9-point prediction score for hematoma expansion was developed and independently validated. The results open a path for individualized treatment and trial design in ICH aimed at patients at highest risk of hematoma expansion with maximum potential for therapeutic benefit.
authors.affiliation: Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston2Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic S.
authors.forename: H Bart
authors.initials: HB
authors.lastname: Brouwers
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston2Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic S.
authors.forename: Guido J
authors.initials: GJ
authors.lastname: Falcone
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Cai
authors.affiliation: Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Ayres
authors.affiliation: Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts Gen.
authors.forename: Thomas W K
authors.initials: TW
authors.lastname: Battey
authors.affiliation: Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vashkevich
authors.affiliation: Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: McNamara
authors.affiliation: Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts Gen.
authors.forename: Valerie
authors.initials: V
authors.lastname: Valant
authors.affiliation: Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Kristin
authors.initials: K
authors.lastname: Schwab
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston.
authors.forename: Susannah C
authors.initials: SC
authors.lastname: Orzell
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Bresette
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Feske
authors.affiliation: Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston2Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic S.
authors.forename: Natalia S
authors.initials: NS
authors.lastname: Rost
authors.affiliation: Neuroradiology Service, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Javier M
authors.initials: JM
authors.lastname: Romero
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kis.
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston.
authors.forename: Sherry H-Y
authors.initials: SH
authors.lastname: Chou
authors.affiliation: Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.affiliation: Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston2Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic S.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kis.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D046648:Hematoma, Subdural, Intracranial / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography