Independent Validation of the Secondary Intracerebral Hemorrhage Score With Catheter Angiography and Findings of Emergent Hematoma Evacuation

BACKGROUND The secondary intracerebral hemorrhage (SICH) score, derived from a cohort of patients with intracerebral hemorrhage examined with computed tomographic (CT) angiography, predicts a patient's risk of harboring a vascular etiology. OBJECTIVE To validate the SICH score in an independent patient population. METHODS We retrospectively reviewed all adults with nontraumatic ICH who presented to our institution during a 5.4-year period and were evaluated with catheter angiography or underwent emergent hematoma evacuation, and applied the SICH score to this cohort. Receiver operating characteristic analysis was performed to determine the area under the curve (AUC) and maximum operating point (MOP). Patients with subarachnoid hemorrhage in the basal cisterns were excluded. RESULTS The study included 341 patients, with a mean age of 57.2 years (range, 18-88). Of these, 179 patients were male (52.5%) and 162 were female (47.5%). Two hundred ninety-two patients were evaluated with catheter angiography (85.6%), and 49 underwent emergent hematoma evacuation (14.4%). The SICH score successfully predicted an increasing risk of underlying vascular etiologies in the independent patient cohort, which was similar to the cohort examined with CT angiography. The MOP was reached at a SICH score >2, with the highest incidence of vascular etiologies in patients with SICH scores of 3 (18.8%), 4 (39%), and 5 (79.2%). There was no significant difference in the AUC between the 2 cohorts (0.82-0.87). CONCLUSION The SICH score successfully predicted the risk of a patient with ICH of harboring a vascular etiology in an independent patient population. This scoring system could be used to select patients with ICH for neurovascular evaluation to exclude an underlying vascular abnormality.