Predicting the presence of macrovascular causes in non-traumatic intracerebral haemorrhage: the DIAGRAM prediction score
Year: 2018
Type: article
Study design: Observational Study
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.
Authors: Nina A Hilkens, Charlotte J J van Asch, David J Werring, Duncan Wilson, Gabriël J E Rinkel, Ale Algra, Birgitta K Velthuis, Gérard A P de Kort, Theo D Witkamp, Koen M van Nieuwenhuizen, Frank-Erik de Leeuw, Wouter J Schonewille, Paul L M de Kort, Diederik W J Dippel, Theodora W M Raaymakers, Jeannette Hofmeijer, Marieke J H Wermer, Henk Kerkhoff, Korné Jellema, Irene M Bronner, Michel J M Remmers, Henri Paul Bienfait, Ron J G M Witjes, H Rolf Jäger, Jacoba P Greving, Catharina J M Klijn
Institutions: Utrecht University, University Medical Center Utrecht, Kempenhaeghe, National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, University College London, Radboud University Nijmegen, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, St. Antonius Ziekenhuis, Elisabeth-TweeSteden Ziekenhuis, Erasmus MC, Meander Medisch Centrum, Rijnstate Hospital, Leiden University Medical Center, Albert Schweitzer Ziekenhuis, Medisch Centrum Haaglanden, Flevoziekenhuis, Amphia Ziekenhuis, Gelre Hospitals, Tergooi
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: ZonMw, Hartstichting
Award: G4156226487
OpenAlex ID: W2782748344