Accuracy of the ABC/2 Score for Intracerebral Hemorrhage: Systematic Review and Analysis of MISTIE, CLEAR-IVH, and CLEAR III

Alastair J S Webb; Natalie L Ullman; Tim C Morgan; John Muschelli; Joshua Kornbluth; Issam A Awad; Stephen Mayo; Michael Rosenblum; Wendy Ziai; Mario Zuccarrello; Francois Aldrich; Sayona John; Sagi Harnof; George Lopez; William C Broaddus; Christine Wijman; Paul Vespa; Ross Bullock; Stephen J Haines; Salvador Cruz-Flores; Stan Tuhrim; Michael D Hill; Raj Narayan; Daniel F Hanley; MISTIE and CLEAR Investigators

doi:10.1161/STROKEAHA.114.007343

Accuracy of the ABC/2 Score for Intracerebral Hemorrhage: Systematic Review and Analysis of MISTIE, CLEAR-IVH, and CLEAR III

Stroke. 2015 Sep;46(9):2470-6. doi: 10.1161/STROKEAHA.114.007343. Epub 2015 Aug 4.

Authors

Alastair J S Webb¹, Natalie L Ullman¹, Tim C Morgan¹, John Muschelli¹, Joshua Kornbluth¹, Issam A Awad¹, Stephen Mayo¹, Michael Rosenblum¹, Wendy Ziai¹, Mario Zuccarrello¹, Francois Aldrich¹, Sayona John¹, Sagi Harnof¹, George Lopez¹, William C Broaddus¹, Christine Wijman¹, Paul Vespa¹, Ross Bullock¹, Stephen J Haines¹, Salvador Cruz-Flores¹, Stan Tuhrim¹, Michael D Hill¹, Raj Narayan¹, Daniel F Hanley²; MISTIE and CLEAR Investigators

Affiliations

¹ From the Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom (A.J.S.W.); Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions, Baltimore, MD (N.L.U., T.C.M., J.K., W.Z., D.F.H.); Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.M., M.R.); Department of Neurosurgery, University of Chicago, IL (I.A.A.); Emissary International, LLC, Austin, TX (S.M.); Department of Neurosurgery, University of Cincinnati, OH (M.Z.); Department of Neurosurgery, University of Maryland, Baltimore (F.A.); Department of Neurology, Rush University Medical Center, Chicago, IL (S.J., G.L.); Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel (S.H.); Department of Neurosurgery, Medical College of Virginia, Richmond (W.C.B., R.B.); Department of Neurology and Neurological Sciences, Stanford Medicine, CA (C.W.); Department of Neurosurgery, University of California, Los Angeles (P.V.); Department of Neurological Surgery, Medical University of South Carolina, Charleston (S.J.H.); St. Louis University, MO (S.C.-F.); Department of Neurology, Mount Sinai School of Medicine, New York, NY (S.T.); Department of Clinical Neurosciences, University of Calgary, Alberta, Canada (M.D.H.); and Department of Neurosurgery, Wayne State University, Detroit, MI (R.N.).
² From the Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom (A.J.S.W.); Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions, Baltimore, MD (N.L.U., T.C.M., J.K., W.Z., D.F.H.); Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.M., M.R.); Department of Neurosurgery, University of Chicago, IL (I.A.A.); Emissary International, LLC, Austin, TX (S.M.); Department of Neurosurgery, University of Cincinnati, OH (M.Z.); Department of Neurosurgery, University of Maryland, Baltimore (F.A.); Department of Neurology, Rush University Medical Center, Chicago, IL (S.J., G.L.); Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel (S.H.); Department of Neurosurgery, Medical College of Virginia, Richmond (W.C.B., R.B.); Department of Neurology and Neurological Sciences, Stanford Medicine, CA (C.W.); Department of Neurosurgery, University of California, Los Angeles (P.V.); Department of Neurological Surgery, Medical University of South Carolina, Charleston (S.J.H.); St. Louis University, MO (S.C.-F.); Department of Neurology, Mount Sinai School of Medicine, New York, NY (S.T.); Department of Clinical Neurosciences, University of Calgary, Alberta, Canada (M.D.H.); and Department of Neurosurgery, Wayne State University, Detroit, MI (R.N.). [email protected].

Abstract

Background and purpose: The ABC/2 score estimates intracerebral hemorrhage (ICH) volume, yet validations have been limited by small samples and inappropriate outcome measures. We determined accuracy of the ABC/2 score calculated at a specialized reading center (RC-ABC) or local site (site-ABC) versus the reference-standard computed tomography-based planimetry (CTP).

Methods: In Minimally Invasive Surgery Plus Recombinant Tissue-Type Plasminogen Activator for Intracerebral Hemorrhage Evacuation-II (MISTIE-II), Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage (CLEAR-IVH) and CLEAR-III trials. ICH volume was prospectively calculated by CTP, RC-ABC, and site-ABC. Agreement between CTP and ABC/2 was defined as an absolute difference up to 5 mL and relative difference within 20%. Determinants of ABC/2 accuracy were assessed by logistic regression.

Results: In 4369 scans from 507 patients, CTP was more strongly correlated with RC-ABC (r(2)=0.93) than with site-ABC (r(2)=0.87). Although RC-ABC overestimated CTP-based volume on average (RC-ABC, 15.2 cm(3); CTP, 12.7 cm3), agreement was reasonable when categorized into mild, moderate, and severe ICH (κ=0.75; P<0.001). This was consistent with overestimation of ICH volume in 6 of 8 previous studies. Agreement with CTP was greater for RC-ABC (84% within 5 mL; 48% of scans within 20%) than for site-ABC (81% within 5 mL; 41% within 20%). RC-ABC had moderate accuracy for detecting ≥5 mL change in CTP volume between consecutive scans (sensitivity, 0.76; specificity, 0.86) and was more accurate with smaller ICH, thalamic hemorrhage, and homogeneous clots.

Conclusions: ABC/2 scores at local or central sites are sufficiently accurate to categorize ICH volume and assess eligibility for the CLEAR-III and MISTIE III studies and moderately accurate for change in ICH volume. However, accuracy decreases with large, irregular, or lobar clots.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: MISTIE-II NCT00224770; CLEAR-III NCT00784134.

Keywords: cerebral hemorrhage; controlled clinical trials, randomized; review, systematic; sensitivity and specificity; tissue-type plasminogen activator.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural
Review
Systematic Review

MeSH terms

Cerebral Hemorrhage / diagnosis*
Cerebral Hemorrhage / pathology
Humans
Severity of Illness Index*

Associated data

ClinicalTrials.gov/NCT00224770
ClinicalTrials.gov/NCT00784134

Abstract

Publication types

MeSH terms

Associated data

Grants and funding