Prediction of hematoma expansion in spontaneous intracerebral hemorrhage: Our institutional experience

Background: Spontaneous intracerebral hemorrhage (sICH) is a disease process with high morbidity and mortality. In particular, hematoma expansion (HE) is a feared complication of sICH. With 15–40% of patients experiencing HE, it has become increasingly important to predict which sICH will remain stable and which will expand. Objective: With new treatment options being developed, it is becoming increasingly important to be able to predict which hemorrhages are at high versus low risk for expansion. The authors of this study hope to reexamine variables associated with hematoma expansion in hopes of generating newer data on risk factors for expansion. Methods: A retrospective analysis identified 334 patients who presented with sICH. The primary outcome was HE on follow up head CT. HE was defined as a greater than 33% increase or an absolute increase in 6 mL or more in overall volume between the two sets of CT images. Analysis was performed using unpaired t-test, Chi-square, and Fisher's exact tests, as appropriate. Results: Of the 334 patients, 247 (74.0%) did not experience an expansion of their ICH while 87 (26.0%) did. Multivariable logistic regression was performed demonstrating ICH score of 3 or greater (4.76 (95% CI 2.60–8.72, p < 0.001), cortical location of the sICH (1.77 (95% CI 1.03–3.04, p = 0.038), and presence of a fluid level (6.46 (95% CI 2.28–18.3, p < 0.001) as significant predictors of HE. Conclusions: Our study found that fluid–fluid levels on non-contrast CT, an ICH score 3 or greater, and lobar sICH were all more likely to expand.