### Description

Wang et al developed the BRAIN algorithm for predicting the risk of hematoma growth following acute intracerebral hemorrhage (ICH). This can help to identify a patient who may benefit from more aggressive management. The authors are from around the world and members of the INTERACT trial.

BRAIN is a mneumonic for the 5 parameters.

Parameters:

(1) baseline ICH volume in mL

(2) recurrent ICH

(3) anticoagulation with warfarin at onset

(4) intraventricular extension

(5) number of hours to baseline CT from symptom onset

 Parameter Finding Points baseline ICH volume < 10 mL 0 10 to 20 mL 5 > 20 mL 7 recurrent ICH no 0 yes 4 anticoagulation no 0 yes 6 intraventricular extension no 0 yes 2 number of hours to baseline CT <= 1 hour 5 1.01 to 2 hours 4 2.01 to 3 hours 3 3.01 to 4 hours 2 4.01 to 5 hours 1 > 5 hours 0

total score =

= SUM(points for all 5 parameters)

Interpretation:

• minimum score: 0

• maximum score: 24

• The higher the score the greater the risk of hematoma growth.

 Score Percent 0 3.4% 1 4.2% 2 5.1% 3 6.3% 4 7.7% 5 9.4% 6 11.3% 7 13.7% 8 16.4% 9 19.5% 10 23.1% 11 27.2% 12 31.6% 13 36.4% 14 41.5% 15 46.7% 16 52.1% 17 57.4% 18 62.5% 19 67.4% 20 71.9% 21 76% 22 79.7% 23 83% 24 85.8%

The algorithm can also be expressed by logistic regression analysis.

X =

= (1.007 if ICH volume > 20 mL) + (1.6009 if volume 10.1 to 20 mL) + (0.7705 for recurrent ICH) + (1.025 for anticoagulation) + (0.4316 for ICH extension) - (0.2141 * (hours for CT from onset) - 2.1644

where:

• In the implementation set maximum hours scored to 6 with MAX(-1.2846,(hours*(-0.2141))).

probability of extension =

= 1 / (1 + EXP((-1) * X))

Performance:

• The area under the ROC curve was 0.73.