Comparison of the efficiency of hematoma expansion scoring in patients with spontaneous intracerebral hemorrhage

Introduction: Spontaneous intracerebral hemorrhage (ISC) constitutes 10-20% of all strokes and has a higher mortality and morbidity than ischemic stroke. After the initial diagnosis with non-contrast brain CT, neuromarkers were investigated and various scores were developed to predict the expansion of bleeding and to determine the prognosis. In our study, we aimed to compare the effectiveness of BRAIN, BAT, HEP, Brouwers scores used to predict intracerebral hemorrhage enlargement in predicting hematoma enlargement, emergency service outcome and 28-day mortality in patients who presented to the emergency department with spontaneous intracerebral hemorrhage. Materials and Methods: All patients who applied to Dokuz Eylül University Hospital Adult Emergency Service between 15.04.2017 and 15.04.2022 and were diagnosed with spontaneous intracerebral hemorrhage and had CTA and control CCT were included in the study. Demographic data, clinical evaluations and laboratory examinations of the patients were learned from the electronic files in HBYS and recorded in the study form. Radiological images were evaluated by neuroradiologists in the study team, and changes in bleeding and neuromarkers were determined on CTs. The effectiveness of four scoring methods used to predict intracerebral hemorrhage enlargement in predicting hematoma enlargement, emergency department outcomes (service hospitalization, intensive care hospitalization, interventional intervention, surgery, death) and 28-day mortality of patients were compared. Results: A total of 43 patients were included in our study, and an increase in hematoma volume was observed in 23 (53.5%) of the patients. The area under the curve (AUC) for predicting volume increase was 0.510 for BRAIN, 0.607 for BAT, 0.538 for Brouwers, and 0.648 for HEP. It was determined that 10 patients (23.3%) died in the first 28 days. HEP score was found to be more successful in predicting mortality (AUC: 0.726 p<0.032). It was observed that a HEP score above 3 was 70% sensitive and 49.5% specific in terms of predicting mortality. In analyzes performed on neuromarkers, hematoma border irregularity was found to be a valuable finding in terms of predicting a decrease of at least two points in GCS, predicting hematoma volume increase, and predicting mortality (OR: 10.292 p=0.001, OR: 6.857 p=0.004, OR: 6.154 p. =0.034). Both Blackhole sign and hypodensity in hematoma were statistically significant in predicting clinical worsening (GCS decrease ≥2 points) (OR: 7.333 p=0.003, OR: 5.657 p=0.011). Conclusion: The HEP score can predict bleeding volume increase by an acceptable margin and predict mortality with statistical significance. Neuromarkers such as hematoma border irregularity, Blackhole sign, and hypodensity in hematoma can be helpful in predicting hematoma expansion and clinical worsening. Hematoma expansion scoring and non-contrast CT neuromarkers should continue to be investigated with larger patient groups and multicenter studies. More powerful prediction score can be done in future studies by combining valuable clinical data with neuromarkers that are not included in the other scores. Keywords: Spontaneous intracerebral hemorrhage, BRAIN score, BAT score, HEP score, Brouwers score, computed tomography of the brain, intracerebral hemorrhage, hematoma expansion, hemorrhage border irregularity, hypodensity, Blackhole sign.