Independent Validation of The Secondary Intracerebral Hemorrhage Score with Catheter
BACKGROUND: The secondary intracerebral hemorrhage (SICH) score, derived from a cohort of ICH patients examined with CT angiography, predicts a patient’s risk of harboring a vascular etiology.
OBJECTIVE: To validate the SICH score in an independent patient population.
METHODS: We retrospectively reviewed all adult non-traumatic ICH patients who presented to our institution during a 5.4-year period and were evaluated with catheter angiography or underwent emergent hematoma evacuation, and applied the SICH score to this cohort. Receiver operating characteristic analysis was performed to determine the area under the curve (AUC) and maximum operating point (MOP). Patients with subarachnoid hemorrhage in the basal cisterns were excluded.
RESULTS: 341 patients were included, with a mean age of 57.2 years (range 18-88 years). 179 patients were male (52.5%) and 162 female (47.5%). 292 patients were evaluated with catheter angiography (85.6%) and 49 underwent emergent hematoma evacuation (14.4%). The SICH score successfully predicted an increasing risk of underlying vascular etiologies in the independent patient cohort, which was similar to the cohort examined with CT angiography. The MOP was reached at a SICH score >2, with the highest incidence of vascular etiologies in patients with SICH scores of 3 (18.8%), 4 (39%) and 5 (79.2%). There was no significant difference in the AUC between both cohorts (0.82-0.87).
CONCLUSION: The SICH score successfully predicted an ICH patient’s risk of harboring a vascular etiology in an independent patient population. This scoring system could be used to select ICH patients for neurovascular evaluation to exclude an underlying vascular abnormality.