Predicting the presence of macrovascular causes in non-traumatic intracerebral haemorrhage: The DIAGRAM prediction score

Nina A. Hilkens, Charlotte J. J. van Asch, David J. Werring, Duncan Wilson, Gabriël J. E. Rinkel, Ale Algra, Birgitta K. Velthuis, G. rard A. P. de Kort, Theo D. Witkamp, Koen M. van Nieuwenhuizen, Frank-Erik de Leeuw, Wouter J. Schonewille, Paul L. M. de Kort, Diederik W. J. Dippel, Theodora W. M. Raaymakers, Jeannette Hofmeijer, Marieke J. H. Wermer, Henk Kerkhoff, Korné Jellema, Irene M. BronnerMichel J. M. Remmers, Henri Paul Bienfait, Ron J. G. M. Witjes, H. Rolf Jäger, Jacoba P. Greving, Catharina J. M. Klijn, H. B. Boogaarts, E. J. van Dijk, W. J. Schonewille, W. M. J. Pellikaan, C. Puppels-de Waard, P. L. M. de Kort, J. P. Peluso, J. H. van Tuijl, J. Hofmeijer, F. B. M. Joosten, D. W. Dippel, L. Khajeh, T. W. M. Raaijmakers, M. J. Wermer, M. A. van Walderveen, H. Kerkhoff, E. Zock, K. Jellema, G. J. Lycklama, I. M. Bronner, M. J. M. Remmers, R. J. G. M. Witjes, H. P. Bienfait, K. E. Droogh-Greve, R. C. J. M. Donders, V. I. H. Kwa, T. H. Schreuder, C. L. Franke, J. S. Straver, C. Jansen, S. L. M. Bakker, C. C. Pleiter, M. C. Visser, C. J. J. van Asch, B. K. Velthuis, G. J. E. Rinkel, K. M. van Nieuwenhuizen, C. J. M. Klijn

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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.
Original languageEnglish
Pages (from-to)674-679
JournalJournal of Neurology, Neurosurgery and Psychiatry
Issue number7
Publication statusPublished - 2018

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