A New Scoring System for Prediction of Underlying Vascular Pathology in Patients with Intracerebral Hemorrhage: The Modified Secondary Intracerebral Hemorrhage Score (mSICH).

BACKGROUND Secondary intracerebral hemorrhage (SICH) score is used to predict risk of intracranial hemorrhage (ICH) associated vascular lesions. However, it has low clinical utility in identifying patients without need for neurovascular imaging. OBJECTIVE This study aims to develop a modified scoring system to capture patients with low risk of underlying vascular pathology, thereby decreasing need for vascular imaging and its associated morbidity. METHODS A retrospective analysis of 994 patients with atraumatic ICH over 8-years was conducted, excluding known underlying pathology, subarachnoid hemorrhage, or lack of vascular imaging. Using a multivariate logistic regression model, independent predictors of vascular pathology were identified and utilized towards developing a modified SICH (mSICH) score. RESULTS Of 575 patients identified, 60 (10.4%) had underlying vascular etiology. Statistically significant predictors of vascular pathology included: age, female gender, admission systolic blood pressure (SBP) <160 mmHg, locations other than basal ganglia, thalamus, pons or midbrain, presence of high-risk imaging features, and proximity to large vessel-containing-cisterns. The mSICH score correlated with an increasing incidence of vascular pathology [0-1 (0%), 9 (4.3%), 12 (9.7%), 21 (40.4%), 6 (33.3%), 8 (88.9%), 4 (100%)] and had a significantly higher number of patients receiving scores with 0% incidence of vascular lesions, compared to the SICH score [159 (27.6%) vs 12 (2.1%); p <.001)]. CONCLUSION The mSICH score can more accurately predict risk of underlying vascular pathology of ICH and identifying patients with lowest risk of vascular pathology. This may minimize the cost and associated risks of invasive cerebrovascular imaging.