Predicting the presence of macrovascular causes in non-traumatic intracerebral haemorrhage: the DIAGRAM prediction score. Issue 7 (18th January 2018)

• Record Type: Journal Article
• Authors: Hilkens, Nina A; van Asch, Charlotte J J; Werring, David J; Wilson, Duncan; Rinkel, Gabriël J E; Algra, Ale; Velthuis, Birgitta K; de Kort, Gérard A P; Witkamp, Theo D; van Nieuwenhuizen, Koen M; de Leeuw, Frank-Erik; Schonewille, Wouter J; de Kort, Paul L M; Dippel, Diederik W J; Raaymakers, Theodora W M; Hofmeijer, Jeannette; Wermer, Marieke J H; Kerkhoff, Henk; Jellema, Korné; Bronner, Irene M; Remmers, Michel J M; Bienfait, Henri Paul; Witjes, Ron J G M; Jäger, H Rolf; Greving, Jacoba P; Klijn, Catharina J M
• Other Names: author non-byline.; De Leeuw F E author non-byline.; Boogaarts H B author non-byline.; van Dijk E J author non-byline.; Schonewille W J author non-byline.; J Pellikaan W M author non-byline.; Waard C Puppels-de author non-byline.; M de Kort P L author non-byline.; Peluso J P author non-byline.; van Tuijl J H author non-byline.; Hofmeijer J author non-byline.; M Joosten F B author non-byline.; Dippel D W author non-byline.; Khajeh L author non-byline.; M Raaijmakers T W author non-byline.; Wermer M J author non-byline.; van Walderveen M A author non-byline.; Kerkhoff H author non-byline.; Zock E author non-byline.; Jellema K author non-byline.; Lycklama à Nijeholt G J author non-byline.; Bronner I M author non-byline.; M Remmers M J author non-byline.; G M Witjes R J author non-byline.; Bienfait H P author non-byline.; Droogh-Greve K E author non-byline.; J M Donders R C author non-byline.; H Kwa V I author non-byline.; Schreuder T H author non-byline.; Franke C L author non-byline.; Straver J S author non-byline.; Jansen C author non-byline.; M Bakker S L author non-byline.; Pleiter C C author non-byline.; Visser M C author non-byline.; J van Asch C J author non-byline.; Velthuis B K author non-byline.; E Rinkel G J author non-byline.; van Nieuwenhuizen K M author non-byline.; M Klijn C J author non-byline.;
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 89:Issue 7(2018)
• Page Start: 674
• Page End: 679
• Publication Date: 2018-01-18
• Subjects: intracerebral haemorrhage -- CT angiography -- digital subtraction angiography -- arteriovenous malformation; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2017-317262
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Objective: A substantial part of non-traumatic intracerebral haemorrhages (ICH) arises from a macrovascular cause, but there is little guidance on selection of patients for additional diagnostic work-up. We aimed to develop and externally validate a model for predicting the probability of a macrovascular cause in patients with non-traumatic ICH. Methods: The DIagnostic AngioGRAphy to find vascular Malformations (DIAGRAM) study (n=298; 69 macrovascular cause; 23%) is a prospective, multicentre study assessing yield and accuracy of CT angiography (CTA), MRI/ magnetic resonance angiography (MRA) and intra-arterial catheter angiography in diagnosing macrovascular causes in patients with non-traumatic ICH. We considered prespecified patient and ICH characteristics in multivariable logistic regression analyses as predictors for a macrovascular cause. We combined independent predictors in a model, which we validated in an external cohort of 173 patients with ICH (78 macrovascular cause, 45%). Results: Independent predictors were younger age, lobar or posterior fossa (vs deep) location of ICH, and absence of small vessel disease (SVD). A model that combined these predictors showed good performance in the development data (c-statistic 0.83; 95% CI 0.78 to 0.88) and moderate performance in external validation (c-statistic 0.66; 95% CI 0.58 to 0.74). When CTA results were added, the c-statistic was excellent (0.91; 95% CI 0.88 to 0.94) and good after external validation (0.88; 95% CI 0.83 to 0.94). Predicted probabilities varied from 1% in patients aged 51–70 years with deep ICH and SVD, to more than 50% in patients aged 18–50 years with lobar or posterior fossa ICH without SVD. Conclusion: The DIAGRAM scores help to predict the probability of a macrovascular cause in patients with non-traumatic ICH based on age, ICH location, SVD and CTA.