TY - JOUR
T1 - Predicting the presence of macrovascular causes in non-traumatic intracerebral haemorrhage
T2 - the DIAGRAM prediction score
AU - Hilkens, Nina A.
AU - van Asch, Charlotte J.J.
AU - Werring, David J.
AU - Wilson, Duncan
AU - Rinkel, Gabriël J.E.
AU - Algra, Ale
AU - Velthuis, Birgitta K.
AU - de Kort, Gerard A.P.
AU - Witkamp, Theo D.
AU - van Nieuwenhuizen, Koen M.
AU - de Leeuw, Frank-Erik
AU - Schonewille, Wouter J.
AU - Hofmeijer, Jeannette
AU - Klijn, Catharina J.M.
AU - DIAGRAM Study Group
PY - 2018/7/1
Y1 - 2018/7/1
N2 - 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% C I 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 nontraumatic ICH based on age, ICH location, SVD and CTA.
AB - 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% C I 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 nontraumatic ICH based on age, ICH location, SVD and CTA.
UR - http://www.scopus.com/inward/record.url?scp=85058332079&partnerID=8YFLogxK
U2 - 10.1136/jnnp-2017-317262
DO - 10.1136/jnnp-2017-317262
M3 - Article
SN - 0022-3050
VL - 89
SP - 674
EP - 679
JO - Journal of neurology, neurosurgery and psychiatry
JF - Journal of neurology, neurosurgery and psychiatry
IS - 7
ER -
