Hematoma shape, hematoma size, Glasgow coma scale score and ICH score: which predicts the 30-day mortality better for intracerebral hematoma?

Chih-Wei Wang; Yi-Jui Liu; Yi-Hsiung Lee; Dueng-Yuan Hueng; Hueng-Chuen Fan; Fu-Chi Yang; Chun-Jen Hsueh; Hung-Wen Kao; Chun-Jung Juan; Hsian-He Hsu

doi:10.1371/journal.pone.0102326

Hematoma shape, hematoma size, Glasgow coma scale score and ICH score: which predicts the 30-day mortality better for intracerebral hematoma?

PLoS One. 2014 Jul 16;9(7):e102326. doi: 10.1371/journal.pone.0102326. eCollection 2014.

Authors

Affiliations

¹ Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China.
² Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan, Republic of China.
³ Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China.
⁴ Department of Pediatrics, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China.
⁵ Department of Neurology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China.

Abstract

Purpose: To investigate the performance of hematoma shape, hematoma size, Glasgow coma scale (GCS) score, and intracerebral hematoma (ICH) score in predicting the 30-day mortality for ICH patients. To examine the influence of the estimation error of hematoma size on the prediction of 30-day mortality.

Materials and methods: This retrospective study, approved by a local institutional review board with written informed consent waived, recruited 106 patients diagnosed as ICH by non-enhanced computed tomography study. The hemorrhagic shape, hematoma size measured by computer-assisted volumetric analysis (CAVA) and estimated by ABC/2 formula, ICH score and GCS score was examined. The predicting performance of 30-day mortality of the aforementioned variables was evaluated. Statistical analysis was performed using Kolmogorov-Smirnov tests, paired t test, nonparametric test, linear regression analysis, and binary logistic regression. The receiver operating characteristics curves were plotted and areas under curve (AUC) were calculated for 30-day mortality. A P value less than 0.05 was considered as statistically significant.

Results: The overall 30-day mortality rate was 15.1% of ICH patients. The hematoma shape, hematoma size, ICH score, and GCS score all significantly predict the 30-day mortality for ICH patients, with an AUC of 0.692 (P = 0.0018), 0.715 (P = 0.0008) (by ABC/2) to 0.738 (P = 0.0002) (by CAVA), 0.877 (P<0.0001) (by ABC/2) to 0.882 (P<0.0001) (by CAVA), and 0.912 (P<0.0001), respectively.

Conclusion: Our study shows that hematoma shape, hematoma size, ICH scores and GCS score all significantly predict the 30-day mortality in an increasing order of AUC. The effect of overestimation of hematoma size by ABC/2 formula in predicting the 30-day mortality could be remedied by using ICH score.

Publication types

Comparative Study
Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Area Under Curve
Cerebral Hemorrhage / diagnosis*
Cerebral Hemorrhage / mortality*
Cone-Beam Computed Tomography
Glasgow Coma Scale*
Hematoma / pathology*
Humans
Predictive Value of Tests
Regression Analysis
Research Design*
Retrospective Studies
Statistics, Nonparametric

Grants and funding

The corresponding author (Chun-Jung Juan) is receiving financial support from National Science Council (NSC 101-2314-B-016-031-MY2), Taiwan, R.O.C. for participating WFNRS 2014, XXth Symposium Neuroradiologicum and presenting this work in part. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.