TY - JOUR
T1 - Accuracy of the ABC/2 Score for Intracerebral Hemorrhage
T2 - Systematic Review and Analysis of MISTIE, CLEAR-IVH, and CLEAR III
AU - Webb, Alastair J S
AU - Ullman, Natalie L.
AU - Morgan, Tim C.
AU - Muschelli, John
AU - Kornbluth, Joshua
AU - Awad, Issam A.
AU - Mayo, Stephen
AU - Rosenblum, Michael
AU - Ziai, Wendy
AU - Zuccarrello, Mario
AU - Aldrich, Francois
AU - John, Sayona
AU - Harnof, Sagi
AU - Lopez, George
AU - Broaddus, William C.
AU - Wijman, Christine
AU - Vespa, Paul
AU - Bullock, Ross
AU - Haines, Stephen J.
AU - Cruz-Flores, Salvador
AU - Tuhrim, Stan
AU - Hill, Michael D.
AU - Narayan, Raj
AU - Hanley, Daniel F.
N1 - Publisher Copyright:
© 2015 American Heart Association, Inc.
PY - 2015/9/28
Y1 - 2015/9/28
N2 - 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: http://www.clinicaltrials.gov. Unique identifier: MISTIE-II NCT00224770; CLEAR-III NCT00784134.
AB - 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: http://www.clinicaltrials.gov. Unique identifier: MISTIE-II NCT00224770; CLEAR-III NCT00784134.
KW - cerebral hemorrhage
KW - controlled clinical trials, randomized
KW - review, systematic
KW - sensitivity and specificity
KW - tissue-type plasminogen activator
UR - https://www.scopus.com/pages/publications/84940434550
UR - https://www.scopus.com/pages/publications/84940434550#tab=citedBy
U2 - 10.1161/STROKEAHA.114.007343
DO - 10.1161/STROKEAHA.114.007343
M3 - Article
C2 - 26243227
AN - SCOPUS:84940434550
SN - 0039-2499
VL - 46
SP - 2470
EP - 2476
JO - Stroke
JF - Stroke
IS - 9
ER -