Original Article
Diagnostic Accuracy of a Simple Clinical Score to Screen for Vascular Abnormalities in Patients with Intracerebral Hemorrhage

https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.03.009Get rights and content

Background

Patients with intracerebral hemorrhage may have vascular abnormalities. There is no consensus about which patients should be studied with angiographic methods. Our aim was to derive a simple clinical score to screen for vascular abnormalities in intracerebral hemorrhage (ICH) and test its accuracy.

Methods

The data were extracted from 2 different registries of patients with ICH. Variables associated with a vascular abnormality were studied in the derivation cohort. We derived a scale by assigning scores to the degree of association. We applied the score to the validation cohort and calculated sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios (LRs), receiver operating curves (ROC) and area under the curve (AUC).

Results

The performance of the scale in the derivation cohort showed the maximum operating point (MOP) at ≥5 (sensitivity .77, specificity .5). In the validation cohort, the MOP was a cutoff point of ≥5 (sensitivity .76, specificity .467). The positive and negative LRs were 2.1 and .6, respectively. The ROC showed similar AUC for both cohorts: .7. The probability of a vascular malformation was 23% with scores ≤5 and 83% with scores ≥9 in the validation cohort.

Conclusions

This simple clinical score can be used immediately on diagnosing an ICH to decide accurately whether to perform an angiographic study or not. Further studies using this simple score should be used to validate it in larger prospective unselected cohorts and consecutive patients.

Section snippets

Derivation Cohort

We retrospectively obtained data from an imaging database of patients with nontraumatic ICH examined at the Instituto de Neurocirugía Asenjo, a tertiary care public hospital in Santiago, Chile, who underwent diagnostic cerebral angiography between August 2003 and December 2005. The initial database included a total of 1840 patients. We included only those patients with an acute ICH (less than 72 hours), diagnosed by CT scan, older than 15 years, and who had no contraindication for DSA. Patients

Derivation Cohort

The sample consisted of 160 cases of spontaneous ICH, mean age 41.4 (standard deviation 14.8), 85 women (53.1%). Eighty-two patients (51.3%) had positive angiographic findings. Demographic and clinical characteristics of patients with or without angiographic findings in the derivation cohort are shown in Table 1. Most cases of positive angiograms were AVMs as shown in Table 2.

Logistic regression analysis showed that younger age (≤50 years) and no history of hypertension were independent factors

Discussion

Our results demonstrate that this simple scoring scale can be used at the bedside of patients with ICH diagnosed using NCCT to decide if they should undergo further vascular imaging. The probability of an underlying vascular malformation is very high if the score is over 8. Increasing scores over 5 will have increasing LRs of changing the pretest probabilities to detect a vascular malformation as the underlying cause if CTA, MRA, or DSA is performed. These LRs range from small to high shifts in

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