title: Clinical prediction algorithm (BRAIN) to determine risk of hematoma growth in acute intracerebral hemorrhage.
abstract: OBJECTIVE
  We developed and validated a simple algorithm to predict the risk of hematoma growth in acute spontaneous intracerebral hemorrhage (ICH) to better inform clinicians and researchers in their efforts to improve outcomes for patients.
  
  
  METHODS
  We analyzed data from the computed tomography substudies of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1 and 2, respectively). The study group was divided into a derivation cohort (INTERACT2, n=964) and a validation cohort (INTERACT1, n=346). Multivariable logistic regression was used to identify factors associated with clinically significant (≥6 mL) increase in hematoma volume at 24 hours after symptom onset. A parsimonious risk score was developed on the basis of regression coefficients derived from the logistic model.
  
  
  RESULTS
  A 24-point BRAIN score was derived from INTERACT2 (C-statistic, 0.73) based on baseline ICH volume (mL per score, ≤10=0, 10-20=5, >20=7), recurrent ICH (yes=4), anticoagulation with warfarin at symptom onset (yes=6), intraventricular extension (yes=2), and number of hours to baseline computed tomography from symptom onset (≤1=5, 1-2=4, 2-3=3, 3-4=2, 4-5=1, >5=0) predicted the probability of ICH growth (ranging from 3.4% for 0 point to 85.8% for 24 points) with good discrimination (C-statistic, 0.73) and calibration (Hosmer-Lemeshow P=0.82) in INTERACT1.
  
  
  CONCLUSIONS
  The simple BRAIN score predicts the probability of hematoma growth in ICH. This could be used to improve risk stratification for research and clinical practice.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00226096 and NCT00716079.
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Xia
authors.initials: X
authors.lastname: Wang
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Rustam
authors.initials: R
authors.lastname: Al-Shahi Salman
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Emma
authors.initials: E
authors.lastname: Heeley
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Lavados
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Thompson
authors.initials: T
authors.lastname: Robinson
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Yining
authors.initials: Y
authors.lastname: Huang
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.).
authors.forename: Candice
authors.initials: C
authors.lastname: Delcourt
authors.affiliation: From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP-HôpitalLariboisière and DHU NeuroVasc Paris-Sorbonne, Univ Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Servicio de Neurología, Departamento de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Universidad de Chile, Santiago, Chile (P.M.L.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK (T.R.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); and The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.). canderson@georgeinstitute.org.au.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000465:Algorithms; D001921:Brain / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D016037:Single-Blind Method
keywords: clinical trial; intracerebral hemorrhage