TY - JOUR
T1 - Predicting the presence of macrovascular causes in non-traumatic intracerebral haemorrhage: 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, G. rard A. P.
AU - Witkamp, Theo D.
AU - van Nieuwenhuizen, Koen M.
AU - de Leeuw, Frank-Erik
AU - Schonewille, Wouter J.
AU - de Kort, Paul L. M.
AU - Dippel, Diederik W. J.
AU - Raaymakers, Theodora W. M.
AU - Hofmeijer, Jeannette
AU - Wermer, Marieke J. H.
AU - Kerkhoff, Henk
AU - Jellema, Korné
AU - Bronner, Irene M.
AU - Remmers, Michel J. M.
AU - Bienfait, Henri Paul
AU - Witjes, Ron J. G. M.
AU - Jäger, H. Rolf
AU - Greving, Jacoba P.
AU - Klijn, Catharina J. M.
AU - Boogaarts, H. B.
AU - van Dijk, E. J.
AU - Schonewille, W. J.
AU - Pellikaan, W. M. J.
AU - Puppels-de Waard, C.
AU - de Kort, P. L. M.
AU - Peluso, J. P.
AU - van Tuijl, J. H.
AU - Hofmeijer, J.
AU - Joosten, F. B. M.
AU - Dippel, D. W.
AU - Khajeh, L.
AU - Raaijmakers, T. W. M.
AU - Wermer, M. J.
AU - van Walderveen, M. A.
AU - Kerkhoff, H.
AU - Zock, E.
AU - Jellema, K.
AU - Lycklama, G. J.
AU - Bronner, I. M.
AU - Remmers, M. J. M.
AU - Witjes, R. J. G. M.
AU - Bienfait, H. P.
AU - Droogh-Greve, K. E.
AU - Donders, R. C. J. M.
AU - Kwa, V. I. H.
AU - Schreuder, T. H.
AU - Franke, C. L.
AU - Straver, J. S.
AU - Jansen, C.
AU - Bakker, S. L. M.
AU - Pleiter, C. C.
AU - Visser, M. C.
AU - van Asch, C. J. J.
AU - Velthuis, B. K.
AU - Rinkel, G. J. E.
AU - van Nieuwenhuizen, K. M.
AU - Klijn, C. J. M.
PY - 2018
Y1 - 2018
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 - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85058332079&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29348301
U2 - https://doi.org/10.1136/jnnp-2017-317262
DO - https://doi.org/10.1136/jnnp-2017-317262
M3 - Article
C2 - 29348301
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 -