Accuracy of the ABC/2 Score for Intracerebral Hemorrhage: Systematic Review and Analysis of MISTIE, CLEAR-IVH, and CLEAR III

Alastair J S Webb, Natalie L. Ullman, Tim C. Morgan, John Muschelli, Joshua Kornbluth, Issam A. Awad, Stephen Mayo, Michael Rosenblum, Wendy Ziai, Mario Zuccarrello, Francois Aldrich, Sayona John, Sagi Harnof, George Lopez, William C. Broaddus, Christine Wijman, Paul Vespa, Ross Bullock, Stephen J. Haines, Salvador Cruz-FloresStan Tuhrim, Michael D. Hill, Raj Narayan, Daniel F. Hanley

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113 Scopus citations


Background and Purpose - The ABC/2 score estimates intracerebral hemorrhage (ICH) volume, yet validations have been limited by small samples and inappropriate outcome measures. We determined accuracy of the ABC/2 score calculated at a specialized reading center (RC-ABC) or local site (site-ABC) versus the reference-standard computed tomography-based planimetry (CTP). Methods - In Minimally Invasive Surgery Plus Recombinant Tissue-Type Plasminogen Activator for Intracerebral Hemorrhage Evacuation-II (MISTIE-II), Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage (CLEAR-IVH) and CLEAR-III trials. ICH volume was prospectively calculated by CTP, RC-ABC, and site-ABC. Agreement between CTP and ABC/2 was defined as an absolute difference up to 5 mL and relative difference within 20%. Determinants of ABC/2 accuracy were assessed by logistic regression. Results - In 4369 scans from 507 patients, CTP was more strongly correlated with RC-ABC (r2=0.93) than with site-ABC (r2=0.87). Although RC-ABC overestimated CTP-based volume on average (RC-ABC, 15.2 cm3; CTP, 12.7 cm3), agreement was reasonable when categorized into mild, moderate, and severe ICH (κ=0.75; P<0.001). This was consistent with overestimation of ICH volume in 6 of 8 previous studies. Agreement with CTP was greater for RC-ABC (84% within 5 mL; 48% of scans within 20%) than for site-ABC (81% within 5 mL; 41% within 20%). RC-ABC had moderate accuracy for detecting ≥5 mL change in CTP volume between consecutive scans (sensitivity, 0.76; specificity, 0.86) and was more accurate with smaller ICH, thalamic hemorrhage, and homogeneous clots. Conclusions - ABC/2 scores at local or central sites are sufficiently accurate to categorize ICH volume and assess eligibility for the CLEAR-III and MISTIE III studies and moderately accurate for change in ICH volume. However, accuracy decreases with large, irregular, or lobar clots. Clinical Trial Registration - URL: Unique identifier: MISTIE-II NCT00224770; CLEAR-III NCT00784134.

Original languageEnglish (US)
Pages (from-to)2470-2476
Number of pages7
Issue number9
StatePublished - Sep 28 2015

Bibliographical note

Publisher Copyright:
© 2015 American Heart Association, Inc.


  • cerebral hemorrhage
  • controlled clinical trials, randomized
  • review, systematic
  • sensitivity and specificity
  • tissue-type plasminogen activator


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