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Front. Neurol. | doi: 10.3389/fneur.2018.00291

Optimal Hematoma Volume Cut-Points to Predict Functional Outcome after Basal Ganglia and Thalamic Hemorrhages

 Kazuma Nakagawa1, 2*, Sage L. King2 and  Todd B. Seto1, 2
  • 1Department of Medicine, University of Hawaii at Manoa, United States
  • 2Queen's Medical Center, United States

Background: Basal ganglia hemorrhage (BG-ICH) and thalamic hemorrhage (TH-ICH) have been historically grouped into a single “deep” hemorrhage group in prior studies. We aimed to assess whether BG-ICH and TH-ICH have different optimal hematoma volume cut-points in predicting functional outcome.
Methods: Patients with BG-ICH and TH-ICH with no pre-existing disabilities who were enrolled in a single-center intracerebral hemorrhage (ICH) cohort study were studied. The hematoma volume of patients who achieved modified Rankin Scale (mRS) of 2 and 3 at 3 months were compared between BG-ICH and TH-ICH groups. Receiver operating characteristic (ROC) curves were created to determine the optimal hematoma volume cut-points in predicting 3-month mRS of 2 and 3 for BG-ICH and TH-ICH groups.
Results: A total of 135 (81 BG-ICH, 54 TH-ICH) patients were studied. The hematoma volume among those with 3-month mRS 2 (BG-ICH: 9.55.4 cm3 vs. TH-ICH: 5.14.9 cm3, p=0.01) and 3-month mRS 3 (BG-ICH: 14.213.4 cm3 vs. TH-ICH: 4.74.1 cm3, p=0.001) were smaller in TH-ICH than BG-ICH. The area under the ROC curve in predicting mRS 2 was 0.838 for BG-ICH (optimal hematoma volume cut-point: 18.0 cm3, sensitivity 72.1%, specificity 95.0%) and 0.802 for TH-ICH (optimal hematoma volume cut-point: 4.6 cm3, sensitivity 83.8%, specificity 70.6%); and in predicting mRS 3 was 0.826 for BG-ICH (optimal hematoma volume cut-point: 28.8 cm3, sensitivity 71.4%, specificity 93.8%) and 0.902 for TH-ICH (optimal hematoma volume cut-point: 5.5 cm3, sensitivity 92.9%, specificity 76.9%).
Conclusions: TH-ICH have smaller optimal hematoma volume cut-points than BG-ICH in predicting functional outcome.

Keywords: intracerebral hemorrhage, prognosis, functional outcome, clinical predictors, hemorrhagic stroke

Received: 19 Feb 2018; Accepted: 16 Apr 2018.

Edited by:

Bryan G. Young, London Health Sciences Centre, Canada

Reviewed by:

Benjamin A. Emanuel, Keck School of Medicine of USC, University of Southern California, United States
Ryan M. Martin, University of California, Davis, United States  

Copyright: © 2018 Nakagawa, King and Seto. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Kazuma Nakagawa, University of Hawaii at Manoa, Department of Medicine, Honolulu, 96813, HI, United States,