Spot Sign Score Predicts Intracerebral Hemorrhage Outcome
Last Updated: 2010-01-19 18:45:24 -0400 (Reuters Health)
NEW YORK (Reuters Health) - In patients with primary intracerebral hemorrhage, the spot sign score is a "potent predictor" of outcome, researchers report in the January issue of Stroke.
"A high spot sign score is not only related to continued intracranial bleed, but also to poor clinical outcome and mortality," principal investigator Dr. Javier Romero told Reuters Health by email.
Dr. Romero and his colleagues at the Massachusetts General Hospital in Boston reviewed computed tomographic angiograms obtained over a 9-year period from 573 consecutive patients with primary intracerebral hemorrhage.
Three neuroradiologists used strict radiological criteria to identify spot signs and calculate a score of 0 to 4 based on the number of spot signs (0 points for no spot signs; 1 point for 1 to 2 signs; 2 points for 3 or more), maximum axial dimension (1 point for 5 mm or more), and maximum attenuation (1 point for 180 HU or more).
Overall, 133 patients (23.2%) had spot signs on 689 angiograms (including 116 that were second-pass scans). In 11 cases, the spot signs were present only on the delayed-acquisition scans. The presence of any spot sign significantly increased the risk of in-hospital mortality (with a positive predictive value of 55.6%; odds ratio 4.0) and poor outcome among survivors at 3-month follow-up (with a positive predictive value of 50.8%; OR 2.5).
The score also predicted escalating risks of both outcomes. For example, patients with a spot sign score of 1 had a 41% predicted risk of in-hospital mortality and a 42% predicted risk of poor outcome. With a score of 4, however, the predicted risks of in-hospital death or poor outcome were 64% and 75%.
In multivariate analysis, spot sign score was an independent predictor of in-hospital mortality (OR, 1.5, p < 0.0002) and poor outcome at 3 months (OR, 1.6, p < 0.0065).
Patients with spot signs had a median hospital stay of 11 days, compared to a median stay of 6 days in patients without spot signs (p < 0.0001).
"Early detection of this sign will likely guide clinicians and neurosurgeons to a more proactive therapy in this particular population that was previously unrecognized," Dr. Romero said.
In fact, lead author Dr. Josser E. Delgado Almandoz (now at Washington University School of Medicine, St. Louis, Missouri) added, "Performing CT angiography immediately upon identifying intracerebral hemorrhage should become part of the routine clinical evaluation of this patient population."
"In the future," he concluded, "we hope that this scoring system could serve to select patients for early hemostatic therapy."
Stroke 2010;41:54-60.
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