• Alastair J S Webb, Natalie L Ullman, Tim C Morgan, John Muschelli, Joshua Kornbluth, Issam A Awad, Stephen Mayo, Michael Rosenblum, Wendy Ziai, Mario Zuccarrello, Francois Aldrich, Sayona John, Sagi Harnof, George Lopez, William C Broaddus, Christine Wijman, Paul Vespa, Ross Bullock, Stephen J Haines, Salvador Cruz-Flores, Stan Tuhrim, Michael D Hill, Raj Narayan, Daniel F Hanley, and MISTIE and CLEAR Investigators.
• From the Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom (A.J.S.W.); Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions, Baltimore, MD (N.L.U., T.C.M., J.K., W.Z., D.F.H.); Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.M., M.R.); Department of Neurosurgery, University of Chicago, IL (I.A.A.); Emissary International, LLC, Austin, TX (S.M.); Department of Neurosurgery, University of Cincinnati, OH (M.Z.); Department of Neurosurgery, University of Maryland, Baltimore (F.A.); Department of Neurology, Rush University Medical Center, Chicago, IL (S.J., G.L.); Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel (S.H.); Department of Neurosurgery, Medical College of Virginia, Richmond (W.C.B., R.B.); Department of Neurology and Neurological Sciences, Stanford Medicine, CA (C.W.); Department of Neurosurgery, University of California, Los Angeles (P.V.); Department of Neurological Surgery, Medical University of South Carolina, Charleston (S.J.H.); St. Louis University, MO (S.C.-F.); Department of Neurology, Mount Sinai School of Medicine, New York, NY (S.T.); Department of Clinical Neurosciences, University of Calgary, Alberta, Canada (M.D.H.); and Department of Neurosurgery, Wayne State University, Detroit, MI (R.N.).
• Stroke. 2015 Sep 1; 46 (9): 2470-6.

Background And PurposeThe ABC/2 score estimates intracerebral hemorrhage (ICH) volume, yet validations have been limited by small samples and inappropriate outcome measures. We determined accuracy of the ABC/2 score calculated at a specialized reading center (RC-ABC) or local site (site-ABC) versus the reference-standard computed tomography-based planimetry (CTP).MethodsIn Minimally Invasive Surgery Plus Recombinant Tissue-Type Plasminogen Activator for Intracerebral Hemorrhage Evacuation-II (MISTIE-II), Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage (CLEAR-IVH) and CLEAR-III trials. ICH volume was prospectively calculated by CTP, RC-ABC, and site-ABC. Agreement between CTP and ABC/2 was defined as an absolute difference up to 5 mL and relative difference within 20%. Determinants of ABC/2 accuracy were assessed by logistic regression.ResultsIn 4369 scans from 507 patients, CTP was more strongly correlated with RC-ABC (r(2)=0.93) than with site-ABC (r(2)=0.87). Although RC-ABC overestimated CTP-based volume on average (RC-ABC, 15.2 cm(3); CTP, 12.7 cm3), agreement was reasonable when categorized into mild, moderate, and severe ICH (κ=0.75; P<0.001). This was consistent with overestimation of ICH volume in 6 of 8 previous studies. Agreement with CTP was greater for RC-ABC (84% within 5 mL; 48% of scans within 20%) than for site-ABC (81% within 5 mL; 41% within 20%). RC-ABC had moderate accuracy for detecting ≥5 mL change in CTP volume between consecutive scans (sensitivity, 0.76; specificity, 0.86) and was more accurate with smaller ICH, thalamic hemorrhage, and homogeneous clots.ConclusionsABC/2 scores at local or central sites are sufficiently accurate to categorize ICH volume and assess eligibility for the CLEAR-III and MISTIE III studies and moderately accurate for change in ICH volume. However, accuracy decreases with large, irregular, or lobar clots.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: MISTIE-II NCT00224770; CLEAR-III NCT00784134.© 2015 American Heart Association, Inc.

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