PT  - JOURNAL ARTICLE
AU  - J.E. Delgado Almandoz
AU  - P.W. Schaefer
AU  - J.N. Goldstein
AU  - J. Rosand
AU  - M.H. Lev
AU  - R.G. González
AU  - J.M. Romero
TI  - Practical Scoring System for the Identification of Patients with Intracerebral Hemorrhage at Highest Risk of Harboring an Underlying Vascular Etiology: The Secondary Intracerebral Hemorrhage Score
AID  - 10.3174/ajnr.A2156
DP  - 2010 Oct 01
TA  - American Journal of Neuroradiology
PG  - 1653--1660
VI  - 31
IP  - 9
4099  - http://www.ajnr.org/content/31/9/1653.short
4100  - http://www.ajnr.org/content/31/9/1653.full
SO  - Am. J. Neuroradiol.2010 Oct 01; 31
AB  - BACKGROUND AND PURPOSE: An ICH patient's risk of harboring an underlying vascular etiology varies according to baseline clinical and NCCT characteristics. Our aim was to develop a practical scoring system to stratify patients with ICH according to their risk of harboring a vascular etiology. MATERIALS AND METHODS: Using a data base of 623 patients with ICH evaluated with MDCTA during a 9-year period, we developed a scoring system based on baseline clinical characteristics (age group [0–2 points], sex [0–1 point], neither known HTN nor impaired coagulation [0–1 point]), and NCCT categorization (0–2 points) to predict the risk of harboring a vascular lesion as the ICH etiology (SICH score). We subsequently applied the SICH score to a prospective cohort of 222 patients with ICH who presented to our emergency department during a 13-month period. Using ROC analysis, we calculated the AUC and MOP for the SICH score in both the retrospective and prospective patient cohorts separately and the entire patient population. Patients with SAH in the basal cisterns were excluded. RESULTS: A vascular etiology was found in 120 of 845 patients with ICH evaluated with MDCTA (14.2%), most commonly AVMs (45.8%), aneurysms with purely intraparenchymal rupture (21.7%), and DVSTs (16.7%). The MOP was reached at a SICH score of >2, with the highest incidence of vascular ICH etiologies in patients with SICH scores of 3 (18.5%), 4 (39%), 5 (84.2%), and 6 (100%). There was no significant difference in the AUC between both patient cohorts (0.86–0.87). CONCLUSIONS: The SICH score successfully predicts a given ICH patient's risk of harboring an underlying vascular etiology and could be used as a guide to select patients with ICH for neurovascular evaluation to exclude the presence of a vascular abnormality. aPTTactivated partial thromboplastin timeAUCarea under the curveAVFarteriovenous fistulaAVMarteriovenous malformationCIconfidence intervalCTACT angiogramDVSTdural venous sinus thrombosisHTNhypertensionICHintracerebral hemorrhageINRinternational normalized ratioIVHintraventricular hemorrhageMDCTAmultidetector CT angiographyMIPmaximum intensity projectionMOPmaximum operating pointNCCTnoncontrast CTROCreceiver operating characteristic analysisSAHsubarachnoid hemorrhageSICHsecondary ICH