Document Detail

The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications.
MedLine Citation:
PMID:  19237905     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Intraventricular extension of intracerebral hemorrhage (IVH) is an independent predictor of poor outcome. IVH volume may be important in outcome prediction and management; however, it is difficult to measure routinely. DESIGN AND PATIENTS: We reviewed the charts and computed tomographies of a cohort of consecutive patients with IVH. The cohort was divided into two groups: index and validation by random sampling. IVH and intracerebral hemorrhage (ICH) volume were measured manually in all patients. IVH was also graded using a simple classification system termed IVH score (IVHS). Clinical outcome was determined by the modified Rankin Scale (mRS) at discharge and in-hospital death. Poor outcome was defined as mRS 4-6. MAIN RESULTS: One hundred seventy-five patients were analyzed, 92 in the index group and 83 in the validation group. Exponential regression yielded the following formula for estimating IVH volume (mL): eIVHS/5 (R = .75, p < 0.001). The IVH estimation formula was then verified in the validation group (R = .8, p < 0.001). The following correlations with mRS were obtained: IVH volume R = .305; ICH volume R = .468; total volume [TV] R = .571 (p < 0.001 for all three correlations). Partial correlation of TV with mRS controlling for ICH volume yielded R = .3 for TV (p < 0.001). Logistic regression model comparing ICH and TV association with poor outcome yielded the following: ICH odds ratio = 5.2, 95% confidence interval 2.3-11.6, p < 0.001; TV odds ratio = 41.6, 95% confidence interval 9.6-180.6, p < 0.001. Substituting TV for ICH volume in the ICH score resulted in a significant increase in the specificity from 64% to 87% for predicting mortality. CONCLUSIONS: IVHS enables clinicians to rapidly estimate IVH volume. The addition of IVH to ICH volume increases its predictive power for poor outcome and mortality significantly. IVHS and TV may be used in clinical practice and clinical trials of patients with ICH.
Hen Hallevi; Nabeel S Dar; Andrew D Barreto; Miriam M Morales; Sheryl Martin-Schild; Anitha T Abraham; Kyle C Walker; Nicole R Gonzales; Kachikwu Illoh; James C Grotta; Sean I Savitz
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Publication Detail:
Type:  Journal Article; Validation Studies    
Journal Detail:
Title:  Critical care medicine     Volume:  37     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-02-24     Completed Date:  2009-03-25     Revised Date:  2010-09-23    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  969-74, e1     Citation Subset:  AIM; IM    
Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA.
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MeSH Terms
Cerebral Hemorrhage / pathology*
Cerebral Ventricles*
Middle Aged
Retrospective Studies
Severity of Illness Index
Grant Support
P50 NS044227-019002/NS/NINDS NIH HHS
Comment In:
Crit Care Med. 2009 Mar;37(3):1152-3   [PMID:  19237944 ]

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