BAT versus BRAIN Score for Prediction of Hematoma Expansion in Spontaneous Intracerebral Hemorrhage: A Prospective Observational Study
Description
Background: Spontaneous intracerebral haemorrhage (ICH) is a major cause of mortality and morbidity globally, with hematoma expansion (HE) being a key predictor of poor outcomes. Identifying patients at high risk for HE is crucial to initiate timely interventions. The BRAIN and BAT scores are two scoring systems that predict HE, but their comparative effectiveness remains unclear.
Objective: This study aimed to evaluate and compare the predictability of hematoma expansion using the BRAIN and BAT scores in patients with spontaneous parenchymal ICH.
Methods: A cross-sectional observational study was conducted at the Department of Neurology, Government Medical College, Kota, from October 2023 to October 2024. A total of 90 patients with spontaneous parenchymal ICH who underwent a non-contrast CT (NCCT) head scan within 6 hours of symptom onset and a follow-up CT at 24 hours were included. Hematoma volume was calculated, and BRAIN and BAT scores were assessed. The relationship between hematoma expansion, clinical parameters, and imaging markers such as blend sign and hypodensities was analysed.
Results: Hematoma expansion occurred in 33 of 90 patients (36.7%), with a higher mean BAT score (2.15 ± 1.48) in patients with HE compared to those without (0.11 ± 0.32, p<0.001). The BAT score showed a stronger correlation with HE than the BRAIN score, which did not show a statistically significant difference between the groups (p = 0.325). Blend sign and hypodensities were strong predictors of HE, with 78.9% of patients with blend sign and 100% of those with hypodensities experiencing hematoma growth (p<0.001). Patients presenting within 2.5 hours of ictus showed a higher rate of HE.
Conclusion: The BAT score demonstrated superior predictive capability for hematoma expansion compared to the BRAIN score. Early identification of high-risk patients using the BAT score, along with recognition of key NCCT markers, may guide to improve clinical outcomes in ICH management