Abstract 31: Ultraearly Hematoma Growth: Multicenter External Validation of the Adjustment of Intracerebral Hemorrhage Volume by Onset-to-imaging Time
Bibliographic record
Abstract
Background: The impact of baseline intracerebral hemorrhage (ICH) volume on hematoma growth (HG) and clinical outcome may vary widely depending on the onset-to-imaging time (OIT). We previously reported that the adjustment of initial ICH volume by OIT (coined as ultraearly HG, uHG) is a powerful tool for outcome prediction in acute ICH. We aimed to validate our previous findings in a multicenter external cohort and to assess the relationship between uHG and the CTA spot-sign. Methods: The PREDICT study was a prospective, observational cohort study of consecutive ICH patients <6 hours. Patients underwent baseline and 24-hour CT scans, and CTA for the blinded detection of spot sign. uHG was defined as the relation between baseline ICH volume/OIT, HG as hematoma expansion >33% or >6 mL, early neurologic deterioration (END) as increase ≥4 points in the NIHSS score or death at 24 hours, and poor outcome as mRS score >2 at 3 months. Results: Two hundred and thirty-seven patients were included in this study. Median baseline ICH volume was 14.5 (6[[Unable to Display Character: –]]30.4) mL, median OIT 135 (85.5[[Unable to Display Character: –]]199) minutes, and median uHG 6.5 (2.5-14.3) mL/h. The spot sign was present in 31.2% of patients. uHG was 2.7-fold higher in spot sign-positive patients (11.1 [5.7-17.7] mL/h vs. 4.1 [1.9-12.3] mL/h, P<0.001). uHG >4.7 mL/h improved the sensitivity-specificity of both baseline ICH volume >10 mL and spot sign in the prediction of HG (73.9%-57.5% vs. 68.1%-54.3% and 48.9%-73.9%), 90-day mortality (82%-56.3% vs. 78%-53.5% and 45.8%-70.8%), and poor outcome (72.9%-80.4% vs. 69.8%-70.6% and 38%-75%), respectively. The median hematoma expansion at 24 hours among spot-positive patients was 3.2 mL in uHG <5 mL/h group, 4.1 mL in uHG 5-10 mL/h group, and 4.8 mL in uHG >10 mL/h group (P<0.001). In adjusted multivariate analyses uHG independently predicted HG (OR 1.08, 95% CI 1.04-1.12), END (OR 1.06, 95% CI 1.02-1.10), 90-day mortality (OR 1.07, 95% CI 1.02-1.11), and poor outcome (OR 1.12, 95% CI 1.02-1.23). Conclusions: These results validate uHG as a powerful predictor of outcome in acute ICH. uHG is significantly higher in spot sign patients, improves the accuracy of baseline ICH volume and spot sign in the prediction of HG and clinical outcome, and independently predicts HG, END, 90-day mortality, and poor outcome.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".