Ultra-Early Hematoma Expansion Is Associated With Ongoing Hematoma Growth and Poor Functional Outcome
Notice bibliographique
Résumé
BACKGROUND: There are limited data on ultra-early hematoma growth dynamics and their clinical impact in primary intracerebral hemorrhage (ICH). We aimed to estimate the incidence of hematoma expansion within the hyperacute period of ICH, describe hematoma dynamics over time, investigate the associations between ultra-early hematoma expansion and clinical outcomes after ICH, and assess the effect of tranexamic acid on ultra-early hematoma expansion. METHODS: We performed a preplanned secondary analysis of the STOP-MSU trial (Stopping Intracerebral Hemorrhage With Tranexamic Acid for Hyperacute Onset Presentation Including Mobile Stroke Units), which compared tranexamic acid with placebo in 201 patients with primary ICH presenting within 2 hours of symptom onset. Repeat computed tomography imaging ≈1 hour after treatment commencement was encouraged (ultra-early reimaging), and patients with this imaging were included in this descriptive study. Imaging analyses were separated into the following time epochs: baseline—the period from onset-to-baseline imaging; ultra-early—the period from baseline imaging to ultra-early reimaging; and interval—the period from ultra-early reimaging to 24-hour reimaging. Hematoma expansion was defined as a ≥33% or ≥6 mL increase from baseline, and functional outcomes were assessed at 90 days (poor functional outcome defined as modified Rankin Scale score of 3–6) using unadjusted logistic regression models. RESULTS: We included 105 patients who had ultra-early reimaging (median age, 66 years; 40% female). Median onset-to-baseline imaging time was 74 minutes (interquartile range, 56–87 minutes), and baseline-to-ultra-early reimaging time was 95 minutes (interquartile range, 74–132 minutes). Forty-one patients (39%) had ultra-early hematoma expansion. These patients had larger baseline hematomas (15.9 mL versus 9.1 mL, P =0.03) compared with those with no early hematoma expansion. Hematoma growth rate declined over time (clustered median regression P <0.01). In 92 patients with imaging at all 3 time points, patients with ultra-early hematoma expansion were more likely to have further interval expansion (9/31 [29%] versus 4/61 [6.6%], P <0.01). Of the 61 patients without ultra-early hematoma expansion, there were 10 (16.4%) whose total growth from baseline to 24-hour imaging fulfilled the expansion definition. Ultra-early hematoma expansion was associated with poor functional outcomes (unadjusted odds ratio, 3.91 [1.22–12.49]; P <0.01) and mortality (unadjusted odds ratio, 6.19 [2.17–17.66]; P <0.01). There was no observed effect of tranexamic acid treatment on ultra-early hematoma expansion ( P =0.65). CONCLUSIONS: In patients with ICH presenting within 2 hours of symptom onset, most hematoma growth occurs in the ultra-early period. The presence of ultra-early hematoma expansion is associated with ongoing hematoma growth, poor functional outcomes, and mortality and represents a target for therapeutic intervention.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».