{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:06:57Z","timestamp":1777943217749,"version":"3.51.4"},"reference-count":25,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2020,11,2]],"date-time":"2020-11-02T00:00:00Z","timestamp":1604275200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hematoma expansion is an important therapeutic target in intracerebral hemorrhage. Recently proposed hematoma expansion definitions have not been validated, and no previous definition has accounted for withdrawal of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To externally validate revised definitions of hematoma expansion that incorporate intraventricular hemorrhage, and to test their validity in the context of withdrawal of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage II trial, comparing revised definitions of hematoma expansion incorporating intraventricular hemorrhage expansion to the conventional definition of \u201c\u22656\u2009mL or \u226533%.\u201d Primary outcome was modified Rankin Scale of 4\u20136 at 90 days. We calculated the incidence, sensitivity, specificity, positive and negative predictive values, and c-statistic for all definitions of hematoma expansion. Definitions were compared using nonparametric methods. Secondary analyses were performed after removing patients with withdrawal of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Primary analysis included 948 patients. Using the conventional definition, the sensitivity was 37.1% and specificity was 83.2% for the primary outcome. Sensitivity improved with all three revised definitions (53.3%, 48.7%, and 45.3%, respectively), with minimal change to specificity (78.4%, 80.5%, and 81.0%, respectively). The greatest improvement was seen with the definition \u201c\u22656\u2009mL or \u226533% or any intraventricular hemorrhage,\u201d with increased c-statistic from 60.2% to 65.9% ( p\u2009&lt;\u20090.001). Secondary analysis excluded 46 participants who experienced withdrawal of care. The revised definitions similarly outperformed the conventional definition in this population, with the greatest improvement in c-statistic using \u201c\u22656\u2009mL or \u226533% or any intraventricular hemorrhage\u201d (58.1% vs. 64.1%, p\u2009&lt;\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Revised hematoma expansion definitions incorporating intraventricular hemorrhage expansion outperformed conventional definitions for predicting poor outcome, even after accounting for care limitations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1747493020967255","type":"journal-article","created":{"date-parts":[[2020,11,2]],"date-time":"2020-11-02T04:48:22Z","timestamp":1604292502000},"page":"640-647","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Revised intracerebral hemorrhage expansion definitions: Relationship with care limitations"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8455-8201","authenticated-orcid":false,"given":"Ronda","family":"Lun","sequence":"first","affiliation":[{"name":"Ottawa Stroke Program, Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8814-6853","authenticated-orcid":false,"given":"Vignan","family":"Yogendrakumar","sequence":"additional","affiliation":[{"name":"Ottawa Stroke Program, Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greg","family":"Walker","sequence":"additional","affiliation":[{"name":"Ottawa Stroke Program, Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada"},{"name":"Division of Neurology, Fraser Health Authority, Royal Columbian Hospital, New Westminster, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0085-6816","authenticated-orcid":false,"given":"Michel","family":"Shamy","sequence":"additional","affiliation":[{"name":"Ottawa Stroke Program, Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1887-5097","authenticated-orcid":false,"given":"Robert","family":"Fahed","sequence":"additional","affiliation":[{"name":"Ottawa Stroke Program, Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adnan","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Zeenat Qureshi Stroke Institutes and Department of Neurology, University of Missouri, Columbia, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1379-3612","authenticated-orcid":false,"given":"Dar","family":"Dowlatshahi","sequence":"additional","affiliation":[{"name":"Ottawa Stroke Program, Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,11,2]]},"reference":[{"key":"bibr1-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1159\/000346599"},{"key":"bibr2-1747493020967255","doi-asserted-by":"crossref","unstructured":"Sprigg N, Flaherty K, Appleton JP, et\u00a0al. Tranexamic acid for hyperacute primary intracerebral haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial.\n                      Lancet\n                      2018; 391(10135): 2107\u201315. doi:10.1016\/S0140-6736(18)31033-X.","DOI":"10.1016\/S0140-6736(18)31033-X"},{"key":"bibr3-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042991"},{"key":"bibr4-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.015062"},{"key":"bibr5-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000208408.98482.99"},{"key":"bibr6-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31828ab2a7"},{"key":"bibr7-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008007"},{"key":"bibr8-1747493020967255","doi-asserted-by":"crossref","unstructured":"Vignan Y, Tim R, Dean FA, et\u00a0al. Redefining hematoma expansion with the inclusion of intraventricular hemorrhage growth.\n                      Stroke\n                      51(4):1120\u20137: STROKEAHA.119.027451. doi:10.1161\/STROKEAHA.119.027451.","DOI":"10.1161\/STROKEAHA.119.027451"},{"key":"bibr9-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182143317"},{"key":"bibr10-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000152045.56837.58"},{"key":"bibr11-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.56.6.766"},{"key":"bibr12-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000069"},{"key":"bibr13-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000261906.93238.72"},{"key":"bibr14-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603460"},{"key":"bibr15-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000232837.34992.32"},{"key":"bibr16-1747493020967255","doi-asserted-by":"crossref","unstructured":"Li Q, Li R, Zhao L-B, et\u00a0al. Intraventricular hemorrhage growth: definition, prevalence and association with hematoma expansion and prognosis.\n                      Neurocrit Care\n                      . Published online 26 March 2020. DOI: 10.1007\/s12028-020-00958-8.","DOI":"10.1007\/s12028-020-00958-8"},{"key":"bibr17-1747493020967255","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"bibr18-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.654970"},{"key":"bibr19-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.018716"},{"key":"bibr20-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-4949.2010.00563.x"},{"key":"bibr21-1747493020967255","doi-asserted-by":"crossref","unstructured":"Dowlatshahi D, Yogendrakumar V, Aviv RI, et\u00a0al. Small intracerebral hemorrhages have a low spot sign prevalence and are less likely to expand.\n                      Int J Stroke\n                      . Published online 18 January 2016. DOI: 10.1177\/1747493015616635.","DOI":"10.1177\/1747493015616635"},{"key":"bibr22-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1214609"},{"key":"bibr23-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70038-8"},{"key":"bibr24-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-019-00783-8"},{"key":"bibr25-1747493020967255","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-019-00876-4"}],"container-title":["International Journal of Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1747493020967255","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1747493020967255","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1747493020967255","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T07:19:14Z","timestamp":1777706354000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1747493020967255"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,2]]},"references-count":25,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1177\/1747493020967255"],"URL":"https:\/\/doi.org\/10.1177\/1747493020967255","relation":{},"ISSN":["1747-4930","1747-4949"],"issn-type":[{"value":"1747-4930","type":"print"},{"value":"1747-4949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,2]]}}}