Validation and Comparison of Noncontrast CT Scores to Predict Intracerebral Hemorrhage Expansion

Loris Poli, Eleonora Leuci, Paolo Costa, Valeria De Giuli, Filomena Caria, Elisa Candeloro, Alessandra Persico, Massimo Gamba, Mauro Magoni, Giuseppe Micieli, Anna Cavallini, Alessandro Padovani, Alessandro Pezzini, Andrea Morotti

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: The BAT, BRAIN, and HEP scores have been proposed to predict hematoma expansion (HE) with noncontrast computed tomography (NCCT). We sought to validate these tools and compare their diagnostic performance.

METHODS: We retrospectively analyzed two cohorts of patients with primary intracerebral hemorrhage. HE expansion was defined as volume growth > 33% or > 6 mL. Two raters analyzed NCCT scans and calculated the scores, blinded to clinical and imaging data. The inter-rater reliability was assessed with the interclass correlation statistic. Discrimination and calibration were calculated with area under the curve (AUC) and Hosmer-Lemeshow χ2 statistic, respectively. AUC comparison between different scores was explored with DeLong test. We also calculated the sensitivity, specificity, positive, and negative predictive values of the dichotomized scores with cutoffs identified with the Youden's index.

RESULTS: A total of 230 subjects were included, of whom 86 (37.4%) experienced HE. The observed AUC for HE were 0.696 for BAT, 0.700 for BRAIN, and 0.648 for HEP. None of the scores had a significantly superior AUC compared with the others (all p > 0.4). All the scores had good calibration (all p > 0.3) and good-to-excellent inter-rater reliability (interclass correlation > 0.8). BAT ≥ 3 showed the highest specificity (0.81), whereas BRAIN ≥ 6 had the highest sensitivity (0.76).

CONCLUSIONS: The BAT, BRAIN, and HEP scores can predict HE with acceptable discrimination and require just a baseline NCCT scan. These tools may be used to stratify the risk of HE in clinical practice or randomized controlled trials.

Original languageEnglish
JournalNeurocritical Care
DOIs
Publication statusE-pub ahead of print - Jul 24 2019

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Cerebral Hemorrhage
Hematoma
Area Under Curve
Tomography
Calibration
Randomized Controlled Trials
Sensitivity and Specificity
Growth

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Validation and Comparison of Noncontrast CT Scores to Predict Intracerebral Hemorrhage Expansion. / Poli, Loris; Leuci, Eleonora; Costa, Paolo; De Giuli, Valeria; Caria, Filomena; Candeloro, Elisa; Persico, Alessandra; Gamba, Massimo; Magoni, Mauro; Micieli, Giuseppe; Cavallini, Anna; Padovani, Alessandro; Pezzini, Alessandro; Morotti, Andrea.

In: Neurocritical Care, 24.07.2019.

Research output: Contribution to journalArticle

Poli, Loris ; Leuci, Eleonora ; Costa, Paolo ; De Giuli, Valeria ; Caria, Filomena ; Candeloro, Elisa ; Persico, Alessandra ; Gamba, Massimo ; Magoni, Mauro ; Micieli, Giuseppe ; Cavallini, Anna ; Padovani, Alessandro ; Pezzini, Alessandro ; Morotti, Andrea. / Validation and Comparison of Noncontrast CT Scores to Predict Intracerebral Hemorrhage Expansion. In: Neurocritical Care. 2019.
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title = "Validation and Comparison of Noncontrast CT Scores to Predict Intracerebral Hemorrhage Expansion",
abstract = "BACKGROUND AND PURPOSE: The BAT, BRAIN, and HEP scores have been proposed to predict hematoma expansion (HE) with noncontrast computed tomography (NCCT). We sought to validate these tools and compare their diagnostic performance.METHODS: We retrospectively analyzed two cohorts of patients with primary intracerebral hemorrhage. HE expansion was defined as volume growth > 33{\%} or > 6 mL. Two raters analyzed NCCT scans and calculated the scores, blinded to clinical and imaging data. The inter-rater reliability was assessed with the interclass correlation statistic. Discrimination and calibration were calculated with area under the curve (AUC) and Hosmer-Lemeshow χ2 statistic, respectively. AUC comparison between different scores was explored with DeLong test. We also calculated the sensitivity, specificity, positive, and negative predictive values of the dichotomized scores with cutoffs identified with the Youden's index.RESULTS: A total of 230 subjects were included, of whom 86 (37.4{\%}) experienced HE. The observed AUC for HE were 0.696 for BAT, 0.700 for BRAIN, and 0.648 for HEP. None of the scores had a significantly superior AUC compared with the others (all p > 0.4). All the scores had good calibration (all p > 0.3) and good-to-excellent inter-rater reliability (interclass correlation > 0.8). BAT ≥ 3 showed the highest specificity (0.81), whereas BRAIN ≥ 6 had the highest sensitivity (0.76).CONCLUSIONS: The BAT, BRAIN, and HEP scores can predict HE with acceptable discrimination and require just a baseline NCCT scan. These tools may be used to stratify the risk of HE in clinical practice or randomized controlled trials.",
author = "Loris Poli and Eleonora Leuci and Paolo Costa and {De Giuli}, Valeria and Filomena Caria and Elisa Candeloro and Alessandra Persico and Massimo Gamba and Mauro Magoni and Giuseppe Micieli and Anna Cavallini and Alessandro Padovani and Alessandro Pezzini and Andrea Morotti",
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day = "24",
doi = "10.1007/s12028-019-00797-2",
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TY - JOUR

T1 - Validation and Comparison of Noncontrast CT Scores to Predict Intracerebral Hemorrhage Expansion

AU - Poli, Loris

AU - Leuci, Eleonora

AU - Costa, Paolo

AU - De Giuli, Valeria

AU - Caria, Filomena

AU - Candeloro, Elisa

AU - Persico, Alessandra

AU - Gamba, Massimo

AU - Magoni, Mauro

AU - Micieli, Giuseppe

AU - Cavallini, Anna

AU - Padovani, Alessandro

AU - Pezzini, Alessandro

AU - Morotti, Andrea

PY - 2019/7/24

Y1 - 2019/7/24

N2 - BACKGROUND AND PURPOSE: The BAT, BRAIN, and HEP scores have been proposed to predict hematoma expansion (HE) with noncontrast computed tomography (NCCT). We sought to validate these tools and compare their diagnostic performance.METHODS: We retrospectively analyzed two cohorts of patients with primary intracerebral hemorrhage. HE expansion was defined as volume growth > 33% or > 6 mL. Two raters analyzed NCCT scans and calculated the scores, blinded to clinical and imaging data. The inter-rater reliability was assessed with the interclass correlation statistic. Discrimination and calibration were calculated with area under the curve (AUC) and Hosmer-Lemeshow χ2 statistic, respectively. AUC comparison between different scores was explored with DeLong test. We also calculated the sensitivity, specificity, positive, and negative predictive values of the dichotomized scores with cutoffs identified with the Youden's index.RESULTS: A total of 230 subjects were included, of whom 86 (37.4%) experienced HE. The observed AUC for HE were 0.696 for BAT, 0.700 for BRAIN, and 0.648 for HEP. None of the scores had a significantly superior AUC compared with the others (all p > 0.4). All the scores had good calibration (all p > 0.3) and good-to-excellent inter-rater reliability (interclass correlation > 0.8). BAT ≥ 3 showed the highest specificity (0.81), whereas BRAIN ≥ 6 had the highest sensitivity (0.76).CONCLUSIONS: The BAT, BRAIN, and HEP scores can predict HE with acceptable discrimination and require just a baseline NCCT scan. These tools may be used to stratify the risk of HE in clinical practice or randomized controlled trials.

AB - BACKGROUND AND PURPOSE: The BAT, BRAIN, and HEP scores have been proposed to predict hematoma expansion (HE) with noncontrast computed tomography (NCCT). We sought to validate these tools and compare their diagnostic performance.METHODS: We retrospectively analyzed two cohorts of patients with primary intracerebral hemorrhage. HE expansion was defined as volume growth > 33% or > 6 mL. Two raters analyzed NCCT scans and calculated the scores, blinded to clinical and imaging data. The inter-rater reliability was assessed with the interclass correlation statistic. Discrimination and calibration were calculated with area under the curve (AUC) and Hosmer-Lemeshow χ2 statistic, respectively. AUC comparison between different scores was explored with DeLong test. We also calculated the sensitivity, specificity, positive, and negative predictive values of the dichotomized scores with cutoffs identified with the Youden's index.RESULTS: A total of 230 subjects were included, of whom 86 (37.4%) experienced HE. The observed AUC for HE were 0.696 for BAT, 0.700 for BRAIN, and 0.648 for HEP. None of the scores had a significantly superior AUC compared with the others (all p > 0.4). All the scores had good calibration (all p > 0.3) and good-to-excellent inter-rater reliability (interclass correlation > 0.8). BAT ≥ 3 showed the highest specificity (0.81), whereas BRAIN ≥ 6 had the highest sensitivity (0.76).CONCLUSIONS: The BAT, BRAIN, and HEP scores can predict HE with acceptable discrimination and require just a baseline NCCT scan. These tools may be used to stratify the risk of HE in clinical practice or randomized controlled trials.

U2 - 10.1007/s12028-019-00797-2

DO - 10.1007/s12028-019-00797-2

M3 - Article

C2 - 31342451

JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

ER -