A Meta-analysis of the Predictive Significance of the Island Sign for Hematoma Expansion in Intracerebral Hemorrhage

Background and purpose Assess the diagnostic accuracy of noncontrast computed tomography (NCCT) markers of hematoma expansion in patients with primary intracerebral hemorrhage. Methods We performed a meta-analysis of observational studies and randomized controlled trials with available data for calculation of sensitivity and specificity of NCCT markers for hematoma expansion (absolute growth >6 or 12.5 mL and/or relative growth >33%). The following NCCT markers were analyzed: irregular shape, island sign (shape-related features); hypodensity, heterogeneous density, blend sign, black hole sign, and swirl sign (density-related features). Pooled accuracy values for each marker were derived from hierarchical logistic regression models. Results A total of 10,363 subjects from 23 eligible studies were included. Significant risk of bias of included studies was noted. Hematoma expansion frequency ranged from 7% to 40%, mean intracerebral hemorrhage volume from 9 to 27.8 ml, presence of NCCT markers from 9% (island sign) to 82% (irregular shape). Among shape features, sensitivity ranged from 0.32 (95%CI = 0.20–0.47) for island sign to 0.68 (95%CI = 0.57–0.77) for irregular shape, specificity ranged from 0.47 (95%CI = 0.36–0.59) for irregular shape to 0.92 (95%CI = 0.85–0.96) for island sign; among density features sensitivity ranged from 0.28 (95%CI = 0.21–0.35) for black hole sign to 0.63 (95%CI = 0.44–0.78) for hypodensity, specificity ranged from 0.65 (95%CI = 0.56–0.73) for heterogeneous density to 0.89 (95%CI = 0.85–0.92) for blend sign. Conclusion Diagnostic accuracy of NCCT markers remains suboptimal for implementation in clinical trials although density features performed better than shape-related features. This analysis may help in better tailoring patients’ selection for hematoma expansion targeted trials.

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Evaluating Hematoma Expansion Scores in Acute Spontaneous Intracerebral Hemorrhage

Stroke ◽

10.1161/strokeaha.119.028574 ◽

2020 ◽

Vol 51 (4) ◽

pp. 1305-1308 ◽

Cited By ~ 2

Author(s):

Vignan Yogendrakumar ◽

Margaret Moores ◽

Lindsey Sikora ◽

Michel Shamy ◽

Tim Ramsay ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

High Performance ◽

Meta Analysis ◽

Descriptive Analysis ◽

Hematoma Expansion ◽

Cochrane Central Register ◽

Spontaneous Intracerebral Hemorrhage ◽

C Statistic ◽

Point Increase ◽

Central Register

Background and Purpose— In acute spontaneous intracerebral hemorrhage, multiple hematoma expansion scores have been proposed for use in clinical trial environments. We performed a systematic scoping review to identify all existing hematoma expansion scores and describe their development, validation, and relative performance. Methods— Two reviewers searched MEDLINE, PUBMED, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) for studies that derived or validated a hematoma expansion prediction score in adults presenting with spontaneous intracerebral hemorrhage. A descriptive analysis of the extracted data was performed, focusing on score development techniques and predictive capabilities. Results— Of the 14 434 records retrieved, 15 studies met inclusion criteria and 10 prediction scores were identified. Validation analysis using independent samples was performed in 9 studies on 5 scores. All derivation studies reported high performance with C statistics ranging from 0.72 to 0.93. In validation, the C-statistic range was broader with studies reporting 0.62 to 0.77. For every score, the risk of expansion increased with each point increase, although patients with high scores were rare. Conclusions— At present, 10 hematoma expansion scores have been developed, of which 5 have been externally validated. Real-world performance in validation studies was lower than performance in derivation studies. Data from the current literature are insufficient to support a meaningful meta-analysis.

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Island Sign Predicts Hematoma Expansion and Poor Outcome After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2020.00429 ◽

2020 ◽

Vol 11 ◽

Cited By ~ 1

Author(s):

Yufei Wei ◽

Guangming Zhu ◽

Yonghong Gao ◽

Jingling Chang ◽

Hua Zhang ◽

...

Keyword(s):

Systematic Review ◽

Intracerebral Hemorrhage ◽

Meta Analysis ◽

Hematoma Expansion ◽

Poor Outcome

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Performance of blend sign in predicting hematoma expansion in intracerebral hemorrhage: A meta-analysis

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2017.10.017 ◽

2017 ◽

Vol 163 ◽

pp. 84-89 ◽

Cited By ~ 8

Author(s):

Zhiyuan Yu ◽

Jun Zheng ◽

Rui Guo ◽

Lu Ma ◽

Mou Li ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Meta Analysis ◽

Hematoma Expansion

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Noncontrast CT markers of intracerebral hemorrhage expansion and poor outcome

Neurology ◽

10.1212/wnl.0000000000010660 ◽

2020 ◽

Vol 95 (14) ◽

pp. 632-643 ◽

Cited By ~ 2

Author(s):

Andrea Morotti ◽

Francesco Arba ◽

Gregoire Boulouis ◽

Andreas Charidimou

Keyword(s):

Intracerebral Hemorrhage ◽

Randomized Controlled Trials ◽

Functional Outcome ◽

Meta Analysis ◽

Hematoma Expansion ◽

Controlled Trials ◽

Randomized Controlled ◽

Poor Outcome ◽

Increased Risk ◽

Noncontrast Ct

ObjectiveTo provide precise estimates of the association between noncontrast CT (NCCT) markers, hematoma expansion (HE), and functional outcome in patients presenting with intracerebral hemorrhage (ICH) through a systematic review and meta-analysis.MethodsWe searched PubMed for English-written observational studies or randomized controlled trials reporting data on NCCT markers of HE and outcome in spontaneous ICH including at least 50 subjects. The outcomes of interest were HE (hematoma growth >33%, >33% and/or >6 mL, >33% and/or >12.5 mL), poor functional outcome (modified Rankin Scale 3–6 or 4–6) at discharge or at 90 days, and mortality. We pooled data in random-effects models and extracted cumulative odds ratio (OR) for each NCCT marker.ResultsWe included 25 eligible studies (n = 10,650). The following markers were associated with increased risk of HE and poor outcome, respectively: black hole sign (OR = 3.70, 95% confidence interval [CI] = 1.42–9.64 and OR = 5.26, 95% CI = 1.75–15.76), swirl sign (OR = 3.33, 95% CI = 2.42–4.60 and OR = 3.70; 95% CI = 2.47–5.55), heterogeneous density (OR = 2.74; 95% CI = 1.71–4.39 and OR = 2.80; 95% CI = 1.78–4.39), blend sign (OR = 3.49; 95% CI = 2.20–5.55 and OR = 2.21; 95% CI 1.16–4.18), hypodensities (OR = 3.47; 95% CI = 2.18–5.50 and OR = 2.94; 95% CI = 2.28–3.78), irregular shape (OR = 2.01, 95% CI = 1.27–3.19 and OR = 3.43; 95% CI = 2.33–5.03), and island sign (OR = 7.87, 95% CI = 2.17–28.47 and OR = 6.05, 95% CI = 4.44–8.24).ConclusionOur results suggest that multiple NCCT ICH shape and density features, with different effect size, are important markers for HE and clinical outcome and may provide useful information for future randomized controlled trials.

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The Function of Tranexamic Acid to Prevent Hematoma Expansion After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis From Randomized Controlled Trials

Frontiers in Neurology ◽

10.3389/fneur.2021.710568 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zeya Yan ◽

Shujun Chen ◽

Tao Xue ◽

Xin Wu ◽

Zhaoming Song ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Tranexamic Acid ◽

Randomized Controlled Trials ◽

Statistical Difference ◽

Meta Analysis ◽

Cochrane Library ◽

Hematoma Expansion ◽

Controlled Trials ◽

Hematoma Volume ◽

Randomized Controlled

Objectives: The clinical results caused by spontaneous intracerebral hemorrhage (ICH) are disastrous to most patient. As tranexamic acid (TXA) has been proved to decrease the influence of ICH, we conducted this research to explore the function of TXA for the prognosis of ICH compared with placebo.Methods: We searched MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov for randomized controlled trials (RCTs) that were performed to evaluate TXA vs. placebo for ICH up to February 2021. The data were assessed by Review Manager 5.3 software. The risk ratio (RR) and mean difference were analyzed using dichotomous outcomes and continuous outcomes, respectively, with a fixed effect model.Results: We collected 2,479 patients from four RCTs. Then, we took the change of hematoma volume, modified Rankin Scale (mRS), and adverse events as evaluation standard of the treatment for ICH. Through statistical analysis, we found that there is no obvious hematoma expansion effect after the application of TXA (RR = 1.05), and we proceeded the quantitative analysis of percentage change in hematoma volume from baseline, indicating that TXA could inhibit the expansion of hematoma volume (RR = −2.02) compared with placebo. However, according to the outcomes of mRS (0–1, RR = 1.04; 0–2, RR = 0.96), TXA cannot improve neurological functional prognosis. As for the security outcomes—mortality (RR = 1.02), thromboembolic events (RR = 0.99), neurological deterioration (RR = 0.92), infection (RR = 0.86), and craniotomy (RR = 0.41), there seems exist no statistical difference between TXA and placebo.Conclusions: TXA has an advantage in the aspect of preventing hematoma expansion compared with placebo for ICH, but cannot illustrate the efficacy of TXA in improving neurological functional prognosis, which still needs more researches with large sample sizes. Moreover, for safety, we did not find obvious statistical difference between TXA and placebo.

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