| Autor: |
Fletcher-Sandersjöö A; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden., Lewén A; Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden., Hånell A; Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden., Nelson DW; Function Perioperative Care and Medicine, Karolinska University Hospital, Stockholm, Sweden.; Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden., Maegele M; Department for Trauma and Orthopedic Surgery, Cologne-Merheim Medical Centre, University Witten/Herdecke, Cologne, Germany.; Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany., Svensson M; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden., Bellander BM; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden., Enblad P; Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden., Thelin EP; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Medical Unit Neurology, Karolinska University Hospital, Stockholm, Sweden., Svedung Wettervik T; Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden. |
| Abstrakt: |
Accurate measurement of traumatic intracranial hematoma volume is important for assessing disease progression and prognosis, as well as for serving as an important end-point 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, subdural (SDHs), and epidural hematomas from admission computed tomography 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 was 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 with 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. |
