The HEP Score: A Nomogram-Derived Hematoma Expansion Prediction Scale

Area of Science:

• Neurology
• Radiology
• Clinical Prediction Tools

Background:

• Intracerebral hemorrhage (ICH) poses significant risks, with substantial hematoma expansion (SHE) correlating with poor outcomes.
• Early identification of patients susceptible to SHE is crucial for targeted therapeutic interventions.

Purpose of the Study:

• To develop and validate a simple scoring system for predicting SHE risk in the hyperacute phase of ICH.
• To create a tool that aids clinicians in identifying patients who may benefit from therapies aimed at limiting hematoma growth.

Main Methods:

• Analysis of CT scan data from 237 spontaneous ICH patients within 12 hours of symptom onset.
• Logistic regression identified six key predictors of SHE, forming the basis of the Hematoma Expansion Prediction (HEP) Score.
• The predictive accuracy of the HEP Score was assessed using c-statistics and calibration.

Main Results:

• Substantial hematoma expansion (SHE) occurred in 31.2% of patients.
• The HEP Score incorporates time to CT, dementia history, smoking, antiplatelet use, Glasgow Coma Scale, and presence of subarachnoid hemorrhage.
• A HEP score greater than 3 indicated the highest risk for SHE, with a validated c-index of 0.76.

Conclusions:

• The developed HEP Score is an accurate and user-friendly tool for predicting SHE risk in ICH patients.
• This score can assist in clinical decision-making and patient stratification for ICH management.
• Further external validation is recommended before widespread clinical application.