当前位置： SCI文献检索 > JAMA Neurology期刊下所有文献 > Predicting hematoma expansion after primary intracerebral hemorrhage.

Predicting hematoma expansion after primary intracerebral hemorrhage.

Abstract：

IMPORTANCE: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. DESIGN, SETTING, AND PARTICIPANTS: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). MAIN OUTCOMES AND MEASURES: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 AND RELEVANCE: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.

journal_name

JAMA Neurol

journal_title

JAMA neurology

authors

Brouwers HB,Chang Y,Falcone GJ,Cai X,Ayres AM,Battey TW,Vashkevich A,McNamara KA,Valant V,Schwab K,Orzell SC,Bresette LM,Feske SK,Rost NS,Romero JM,Viswanathan A,Chou SH,Greenberg SM,Rosand J,Goldstein JN

doi

10.1001/jamaneurol.2013.5433

subject

Has Abstract

pub_date

2014-02-01 00:00:00

pages

158-64

issue

eissn

2168-6149

issn

2168-6157

pii

1790168

journal_volume

pub_type

杂志文章,多中心研究

在线工具

Predicting hematoma expansion after primary intracerebral hemorrhage.