A Meta-analysis of the Predictive Significance of the Island Sign for Hematoma Expansion in Intracerebral Hemorrhage

Abstract

Background: The island sign of non-contrast computed tomography is a risk factor for hematoma expansion (HE) after spontaneous intracerebral hemorrhage, but has inconsistent conclusions. A meta-analysis was performed to investigate the predictive accuracy of island sign for HE.

Methods: A systematic review of published literature on island sign and hematoma expansion was conducted. The pooled sensitivity, specificity, and summary receiver operating characteristics curve (SROC) were generated. The publication bias was assessed by Deeks' funnel plot asymmetry test.

Results: Nine studies with a total of 2939 patients were included in the present study. The pooled sensitivity and specificity of island sign for predicting hematoma expansion was 0.50 and 0.89, respectively. The area under the curve was 0.73 in the SROC curve. There was no significant publication bias.

Conclusions: This meta-analysis suggests that island sign of non-contrast computed tomography has a good predictive accuracy for hematoma enlargement in intracerebral hemorrhage.

Keywords: Hematoma expansion; Intracerebral hemorrhage; Island sign; Meta-analysis.