Abstract Details

Title Hematoma Expansion in Intracerebral Hemorrhage: Who are the Super-expanders?

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-018

Objective We aimed to identify a group of patients most at risk for severe expansion of acute intracerebral hemorrhage (ICH), who we labeled as "super-expanders."

Background While some studies have shown that ICH expansion correlates with poor outcomes, characteristics of patients with severe hematoma expansion have not been definitively characterized. Super-expanders are a group of ICH patients most likely to benefit from aggressive intervention to prevent deterioration.

Design/Methods We retrospectively reviewed baseline clinical and radiological features in consecutive ICH patients admitted over a three-year period to a comprehensive stroke center. Hematoma expansion was defined conventionally as a > 33% increase in hematoma volume or a > 6ml increase in absolute hematoma volume between the baseline and 24-hour follow-up brain CT. Severe hematoma expansion was defined as a > 50% increase in ICH volume associated with a decrease in the Glasgow Coma Scale of at least four points. We used Random Forest (RF) to generate importance plots searching for the determinants of super-expanders in ICH. In addition, a multivariable logistic regression model was done to examine independent factors associated with super-expanders.

Results Hematoma expansion occurred in 97 of the analyzed 417 (23%) patients, of which 15 (4%) were deemed super-expanders. Per univariate analysis, super-expanders were more likely to have lobar hemorrhage, spot sign, and increased in-hospital mortality. Using RF analysis the following were identified as important determinants of super-expansion: age, platelet count, and presence of a spot sign. Per multivariable model, only spot sign was an independent predictor for super-expansion [age (OR = 1.43, CI=0.61, 3.37), spot sign (OR = 6.25, CI=2.30-17.00), lobar location (OR = 4.63, CI= 0.92-23.42)].

Conclusions We found a low incidence of 4% of severe hematoma expansion in ICH. Super-expanders were not definitively differentiated via the clinical/radiological characteristics examined. We encourage future studies focused on illuminating effective early identification of super-expanders.

Authors/Disclosures
Tiffany A. Eatz, MD (University of Miami Miller School of Medicine) PRESENTER	Dr. Eatz has nothing to disclose.
Sebastian Koch, MD (University of Miami)	Dr. Koch has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple Legal Matters. Dr. Koch has received stock or an ownership interest from Cerepeutics. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care.
Berje H. Shammassian, MD (LSUHSC - New Orleans/University Medical Center)	Dr. Shammassian has nothing to disclose.
Lili Zhou	Lili Zhou has received personal compensation for serving as an employee of Baptist Health South Florida.
Nicole B. Sur, MD (University of Miami)	Dr. Sur has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Sur has received research support from Florida Stroke Registry. The institution of Dr. Sur has received research support from Miami CTSI & NIH/NINDS.
Gillian L. Gordon-Perue, MD, FAAN (University of Miami)	The institution of Dr. Gordon-Perue has received research support from CDC Paul Coverdell Grant. The institution of Dr. Gordon-Perue has received research support from Florida Department of Health. Dr. Gordon-Perue has received personal compensation in the range of $500-$4,999 for serving as a Moderator with PRIME ECHO Stroke ��ɫ��al Webinar.
Amedeo Merenda, MD (Univeristy of Miami Miller School of Medicine)	Dr. Merenda has nothing to disclose.
Ayham M. Alkhachroum, MD (Columbia University Medical Center)	The institution of Dr. Alkhachroum has received research support from Miami CTSI.

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