Resident physician University of Virginia Charlottesville, Virginia, United States
Disclosure(s):
Natasha T. Ironside, MBChB: No financial relationships to disclose
Introduction: Hematoma expansion (HE) is an important contributor to outcome in intracerebral hemorrhage (ICH). An increase of 33% or 6mL in hematoma volume has traditionally been recognized as significant HE. However, these thresholds bear little, if any, clinical relevance as hematoma location is a critical determinant of hematoma volume tolerance and hence clinical outcome. We aimed assess the effect of interaction between ICH location and HE on clinical outcome and to identify clinically significant HE thresholds for different ICH locations
Methods: This study utilized serial CT scans from the VISTA and SHRINC clinical trials databases. Relative and absolute hematoma volume increase between initial and 24hr CT scans were quantified, and location was categorized into deep and lobar. Models informing clinical outcome were developed including: (1) volume increase and location; and (2) volume increase, location, and their interaction term. Sensitivity/specificity versus probability cutoff plots were generated for each location.
Results: A total of 987 spontaneous ICH patients were analyzed. The interaction between relative volume increase and location was a significant predictor of discharge (OR=1.398[1.121,1.742],p=0.003) and 90-day (OR=1.345[1.075,1.685],p=0.010) modified Rankin Scale (mRS) scores. Similarly, the interaction between absolute volume increase and location was a significant predictor of discharge (OR=1.270[1.049-1.539],p=0.014) and 90-day (OR=1.250[1.029,1.518],p=0.025) mRS scores. The optimal volume increase cutpoints for worse discharge mRS were 0.86mL or 5.1% in deep and 6.91mL or 19.2% in lobar ICH. The optimal volume increase cutpoints for worse 90-day mRS were 9.66mL or 9.3% in deep and 26.64mL or 25.0% in lobar ICH. The sensitivity and specificity of these threshold volumes were 65% and 81% for discharge, and 78% and 85% for 90-day mRS.
Conclusion : The effect of HE on outcome is modified by location. Deep locations have a lower tolerance for HE compared to lobar. ICH location should be a major consideration in patient selection for therapies that target HE.
