Volumetric assessment of traumatic intracranial hematomas: is ABC/2 reliable?

医学 血肿 一致性 创伤性脑损伤 威尔科克森符号秩检验 斯皮尔曼秩相关系数 一致相关系数 脑出血 秩相关 核医学 放射科 外科 格拉斯哥昏迷指数 内科学 统计 曼惠特尼U检验 精神科 数学
作者
Alexander Fletcher‐Sandersjöö,Anders Lewén,Anders Hånell,David K. Menon,Marc Maegele,Mikael Svensson,Bo‐Michael Bellander,Per Enblad,Eric Peter Thelin,Teodor Mikael Svedung Wettervik
出处
期刊:Journal of Neurotrauma [Mary Ann Liebert]
标识
DOI:10.1089/neu.2024.0248
摘要

Accurate measurement of traumatic intracranial hematoma volume is important for assessing disease progression and prognosis, as well as serving as an important endpoint in clinical trials aimed at preventing hematoma expansion. While the ABC/2 formula has traditionally been used for volume estimation in spontaneous intracerebral hemorrhage, its adaptation to traumatic hematomas lacks validation. This study aimed to compare the accuracy of ABC/2 with computer-assisted volumetric analysis (CAVA) in estimating the volumes of traumatic intracranial hematomas. We performed a dual-center observational study that included adult patients with moderate-to-severe traumatic brain injury. Volumes of intracerebral (ICH), subdural (SDH), and epidural hematomas (EDH) from admission CT scans were measured using ABC/2 and CAVA, and compared using the Wilcoxon signed-rank test, Spearman's rank correlation, Lin's concordance correlation coefficient (CCC), and Bland-Altman plots. Prognostic significance for outcomes were evaluated through logistic and linear regression models. In total, 1,179 patients with 1,543 hematomas were included. Despite a high correlation (Spearman coefficients between 0.95 and 0.98) and excellent concordance (Lin's CCC from 0.89 to 0.96) between ABC/2 and CAVA, ABC/2 overestimated hematoma volumes compared to CAVA, in some instances exceeding 50 ml. Bland-Altman analysis highlighted wide limits of agreement, especially in SDH. While both methods demonstrated comparable accuracy in predicting outcomes, CAVA was slightly better at predicting craniotomies and midline shift. We conclude that while ABC/2 provides a generally reliable volumetric assessment suitable for descriptive purposes and as baseline variables in studies, CAVA should be the gold standard in clinical situations and studies requiring more precise volume estimations, such as those using hematoma expansion as an outcome.
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