Development and validation of the nomogram model derived non-contrast CT score to predict hematoma expansion in patients with spontaneous intracerebral hemorrhage.

Aims: Develop and validate new non-contrast computed tomography (NCCT) score to predict hematoma expansion (HE) in spontaneous intracerebral hemorrhage (SICH) patients based on hematoma's shape irregularity and density heterogeneity.

Materials And Methods: Retrospective study was conducted among 136 patients for development and 90 patients for validation at two separate hospitals. SICH patients with NCCT scanned within 6 hours of symptoms and follow-up NCCT scanned within 24 hours were enrolled. Black hole sign and blend sign were integrated as combined heterogeneity; likewise, satellite sign and island sign were integrated as combined irregularity. Binary logistic regression analysis screened the covariates associated with HE. Nomogram was generated using the predicted value of binary logistic regression model to derive NCCT score to predict HE.

Results: A total of 65 patients had HE in developmental cohort, where history of hypertension [odds ratio (OR) 2.56; 95% CI 1.169-5.607; P=0.019], initial NCCT time ≤ 3 hours (OR 2.50; 95% CI 1.169-5.327; P=0.018), combined heterogeneity (OR 2.50; 95% CI 1.160-5.365; P=0.019), and combined irregularity (OR 2.63; 95% CI 1.164-5.942; P=0.020) were independently associated with HE. A score was derived and a single point was allocated to each independently associated variable. HE was observed in 35 patients in validation cohort, which showed a proportional increase in the probability of HE with an increase in score accumulated.

Conclusion: New four-point NCCT score to predict HE was developed and validated, which may be regarded as fair predictive score where advance facilities are rarely available.