Diagnostic accuracy of a simple clinical score to screen for vascular abnormalities in patients with intracerebral hemorrhage

Abstract

Background: Patients with intracerebral hemorrhage may have vascular abnormalities. There is no consensus about which patients should be studied with angiographic methods. Our aim was to derive a simple clinical score to screen for vascular abnormalities in intracerebral hemorrhage (ICH) and test its accuracy.

Methods: The data were extracted from 2 different registries of patients with ICH. Variables associated with a vascular abnormality were studied in the derivation cohort. We derived a scale by assigning scores to the degree of association. We applied the score to the validation cohort and calculated sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios (LRs), receiver operating curves (ROC) and area under the curve (AUC).

Results: The performance of the scale in the derivation cohort showed the maximum operating point (MOP) at ≥5 (sensitivity .77, specificity .5). In the validation cohort, the MOP was a cutoff point of ≥5 (sensitivity .76, specificity .467). The positive and negative LRs were 2.1 and .6, respectively. The ROC showed similar AUC for both cohorts: .7. The probability of a vascular malformation was 23% with scores ≤5 and 83% with scores ≥9 in the validation cohort.

Conclusions: This simple clinical score can be used immediately on diagnosing an ICH to decide accurately whether to perform an angiographic study or not. Further studies using this simple score should be used to validate it in larger prospective unselected cohorts and consecutive patients.

Keywords: Intracerebral hemorrhage; angiography; diagnostic criteria; vascular abnormality.