Combining Spot Sign and Intracerebral Hemorrhage Score to Estimate Functional Outcome: Analysis From the PREDICT Cohort

Background and Purpose— The intracerebral hemorrhage (ICH) score is the most commonly used grading scale for stratifying functional outcome in patients with acute ICH. We sought to determine whether a combination of the ICH score and the computed tomographic angiography spot sign may improve outcome prediction in the cohort of a prospective multicenter hemorrhage trial. Methods— Prospectively collected data from 241 patients from the observational PREDICT study (Prediction of Hematoma Growth and Outcome in Patients With Intracerebral Hemorrhage Using the CT-Angiography Spot Sign) were analyzed. Functional outcome at 3 months was dichotomized using the modified Rankin Scale (0–3 versus 4–6). Performance of (1) the ICH score and (2) the spot sign ICH score—a scoring scale combining ICH score and spot sign number—was tested. Results— Multivariable analysis demonstrated that ICH score (odds ratio, 3.2; 95% confidence interval, 2.2–4.8) and spot sign number (n=1: odds ratio, 2.7; 95% confidence interval, 1.1–7.4; n>1: odds ratio, 3.8; 95% confidence interval, 1.2–17.1) were independently predictive of functional outcome at 3 months with similar odds ratios. Prediction of functional outcome was not significantly different using the spot sign ICH score compared with the ICH score alone (spot sign ICH score area under curve versus ICH score area under curve: P =0.14). Conclusions— In the PREDICT cohort, a prognostic score adding the computed tomographic angiography–based spot sign to the established ICH score did not improve functional outcome prediction compared with the ICH score.