Abstract 100: Small Intracerebral Hematomas Have A Low Spot Sign Prevalence And Are Unlikely To Expand
Bibliographic record
Abstract
Background: Early intracerebral hemorrhage (ICH) expansion is a major determinant of poor clinical outcome. We previously reported baseline hematoma volume was a predictor of hematoma expansion (HE), and that hematomas <3mL may represent a subgroup with good prognosis. Our objective was to validate our previous findings in a multi-centre prospective observational cohort, and to assess the relationship between baseline hematoma size and the CTA spot-sign. We hypothesized that small hematomas are less likely to expand, and have low spot-sign prevalence. Methods: The PREDICT study is a prospective, observational cohort study of consecutive patients with acute ICH. Inclusion criteria are age>18, symptom onset <6 hours, and baseline CT and CTA; exclusions are baseline ICH >100ml, planned ICH surgery within 24 hours, known secondary cause of ICH, known renal impairment, GCS<6, or premorbid disability or terminal illness. Scans were reviewed for spot sign presence/absence by a neuroradiologist blinded to outcomes and follow-up imaging. Volumes were measured by planimetry by a neurologist blinded to CTA images and outcomes. The predictor of interest was baseline hematoma volume which was stratified as <3mL, 3-9mL, 10-19mL, 20-29mL and >30mL based on our prior study. Primary outcome was significant HE defined as ≥6mL. We used multivariable models to calculate adjusted odds ratios (aOR) for HE. Findings: Two-hundred and sixty-eight patients were enrolled from 11 centers in 6 countries: HE analysis was limited to 228 patients with follow-up CT before rFVIIa or surgical intervention. Median baseline hematoma volume was 12.4ml, spot-sign was present in 26.8% of patients, and 25% of patients had HE of ≥6ml. HE and spot sign prevalence increased with increasing baseline hematoma volume (see table ) . Only one patient with volume <3ml had HE; the patient was on warfarin (INR 2.2) but spot negative. Two patients with volumes <3ml were spot positive, but neither had HE. When compared to hematomas >30ml, the aOR for HE was 0.09 for <3ml hematomas, 0.14 for 3-9ml, 0.49 for 10-20ml, and 1.83 for 20-30ml (p<0.001). Associations between baseline hematoma volume and clinical outcomes will be presented. Discussion: Our results validate baseline hematoma volume as a predictor of HE. Furthermore, spot sign prevalence is associated with baseline hematoma volume. These results can inform ICH trial design and clinical prognostication at the bedside: small hematomas have a low spot sign prevalence and are unlikely to expand ≥6 ml, even when spot positive. Conversely, half of hematomas >30ml are spot positive and will expand.
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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 | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".