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

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).
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.
In 4369 scans from 507 patients, CTP was more strongly correlated with RC-ABC (r(2)=0.93) than with site-ABC (r(2)=0.87). Although RC-ABC overestimated CTP-based volume on average (RC-ABC, 15.2 cm(3); 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.
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.
URL: http://www.clinicaltrials.gov. Unique identifier: MISTIE-II NCT00224770; CLEAR-III NCT00784134.
AuthorsAlastair 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-Flores, Stan Tuhrim, Michael D Hill, Raj Narayan, Daniel F Hanley,
JournalStroke; a journal of cerebral circulation (Stroke) Vol. 46 Issue 9 Pg. 2470-6 (Sep 2015) ISSN: 1524-4628 [Electronic] United States
PMID26243227 (Publication Type: Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural, Review)
Copyright© 2015 American Heart Association, Inc.
  • Cerebral Hemorrhage (diagnosis, pathology)
  • Humans
  • Severity of Illness Index

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