A Clinical Predictive Nomogram for Traumatic Brain Parenchyma Hematoma Progression

Area of Science:

• Neurosurgery
• Radiology
• Critical Care Medicine

Background:

• Acute traumatic intraparenchymal hematoma (tICH) expansion is a primary driver of clinical deterioration following brain contusion.
• Accurate prediction of tICH expansion is crucial for timely intervention and improved patient outcomes.

Purpose of the Study:

• To develop and validate an accurate prediction tool for acute tICH expansion.
• To identify key predictors of tICH expansion for clinical application.

Main Methods:

• A multicenter hospital-based study involving 889 patients for model development and 264 for external validation.
• Utilized semi-automated software for tICH volume assessment and developed two multivariate predictive models.
• Externally validated the predictive models for acute tICH expansion.

Main Results:

• The novel Traumatic Parenchymatous Hematoma Expansion Aid (TPHEA) model identified key predictors: age, coagulopathy, baseline tICH volume, time to baseline CT, subdural hemorrhage, multihematoma fuzzy sign, and monocyte-to-lymphocyte ratio.
• The TPHEA model demonstrated superior discrimination, calibration, and clinical net benefits compared to existing models and individual markers.
• A TPHEA nomogram was developed for simplified clinical application, showing good predictive performance in an external dataset.

Conclusions:

• The TPHEA nomogram effectively predicts acute tICH expansion using the monocyte-to-lymphocyte ratio, baseline tICH volume, and multihematoma fuzzy sign.
• This user-friendly tool aids in estimating acute tICH expansion, enabling optimized personalized treatment strategies for brain contusion patients.