Predictors of hematoma expansion in acute intracerebral hemorrhage

急性脑出血血肿扩张的预测因子

• 批准号: 8423067
• 负责人: Joshua N Goldstein
• 金额: $ 16.59万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8423067
• 关键词: Acute; Address; Adverse effects; Angiography; Basic Science; Biological Markers; Biometry; Bleeding time procedure; Blood - brain barrier anatomy; Blood Tests; Brain; Cause of Death; Cerebral hemisphere hemorrhage; Cerebrovascular Disorders; Clinical; Clinical Investigator; Clinical Research; Cohort Studies; Complication; Data Set; Development; Disease; Edema; Effectiveness; Emergency Medicine; Emergency Situation; Enrollment; Epidemiology; Extramural Activities; Extravasation; Faculty; Foundations; Fright; Functional disorder; Funding; Future; Goals; Grant; Hematoma; Hemorrhage; Hemostatic Agents; Image; Intervention; Laboratories; Laboratory Markers; Measures; Mentors; Mentorship; Modeling; National Institute of Neurological Disorders and Stroke; Neurological emergencies; Neurological outcome; Neurology; Observational Study; Outcome; Outcome Assessment; Patient Care; Patients; Phase; Physicians; Process; Public Health Schools; Research; Research Methodology; Research Personnel; Research Training; Risk; Scientist; Sensitivity and Specificity; Serum; Specialist; Stroke; Symptoms; Time; Training; United States; Work; X-Ray Computed Tomography; base; career development; disability; follow-up; improved; innovation; member; patient oriented research; programs; prospective

DESCRIPTION (provided by applicant): PROJECT SUMMARY: Dr. Goldstein is an emergency physician with a long-term goal of improving the care of patients with neurological emergencies. Intracerebral hemorrhage (ICH) is the most fatal form of stroke, and no proven therapies are available. Hematoma expansion is the most feared complication of this disease, and therapies targeting this expansion are likely to be critical for improving outcome. A bedside predictor of expansion would allow acute therapies to be specifically targeted to those patients likely to benefit, while sparing those who will not develop expansion from the side effects of such therapies. Dr. Goldstein has an established foundation in basic and clinical research, and seeks further training in research methods and faculty development under the mentorship of two nationally recognized experts in ICH and emergency medicine. Drs. Greenberg and Camargo have a track record of independent extramural funding, and of mentoring clinicians who have developed into active clinical investigators. This proposal includes the close integration of clinical specialists in neurology, neuroradiology, emergency medicine, and biostatistics. This prospective observational study of patients with acute intracerebral hemorrhage has the following aims: 1) Determine whether contrast extravasation visualized on CT angiography (CTA) predicts subsequent hematoma expansion; 2) Determine whether contrast extravasation independently predicts poor long-term outcome; 3) Determine whether serum biomarkers in the acute setting predict hematoma expansion; 4) Develop a prediction rule that can be used to acutely guide therapy; 5) Obtain formal training in neuroradiology and the use of imaging to emergently risk-stratify patients; 6) Obtain formal training in biostatistics and epidemiology through a Master's level program at the Harvard School of Public Health. The proposal will lay the foundations for future trials guiding acute therapy to patients at risk of hematoma expansion. This training grant will provide critical support for Dr. Goldstein's transition into an independent clinical scientist who performs patient-oriented research in neurologic emergencies. RELEVANCE: The most deadly form of stroke is bleeding in the brain. While some treatments may help, they also have side effects, and we don't know which people will receive more benefit than harm from these therapies. This proposal will establish a way to use CT scans and blood tests to decide who will benefit from which treatment.

项目简介：Goldstein博士是一名急诊医生，长期致力于改善神经急症患者的护理。脑出血（ICH）是中风最致命的形式，目前还没有经过证实的治疗方法。血肿扩张是这种疾病最可怕的并发症，针对这种扩张的治疗可能对改善结果至关重要。扩展的床边预测器将允许急性治疗专门针对那些可能受益的患者，同时使那些不会因此类治疗的副作用而发展为扩展的患者免受影响。Goldstein博士在基础和临床研究方面有良好的基础，并在两位国家认可的脑出血和急诊医学专家的指导下寻求进一步的研究方法和师资发展培训。Drs。格林伯格和卡马戈有独立的校外资助记录，并指导临床医生发展成为活跃的临床研究者。该建议包括神经病学、神经放射学、急诊医学和生物统计学的临床专家的紧密结合。本研究对急性脑出血患者进行前瞻性观察，目的如下：1)确定CT血管造影（CTA）造影剂外渗是否能预测后续血肿扩张；2)确定造影剂外渗是否独立预测不良的长期预后；3)确定急性期血清生物标志物是否能预测血肿扩张；4)建立可用于急性指导治疗的预测规则；5)接受正规的神经放射学培训，并使用影像学对患者进行紧急风险分层；6)通过哈佛大学公共卫生学院的硕士课程获得生物统计学和流行病学方面的正式培训。该建议将为未来的试验奠定基础，指导对血肿扩大风险患者的急性治疗。这项培训经费将为Goldstein博士转变为一名独立的临床科学家提供关键支持，他将在神经急症中进行以患者为导向的研究。相关性：中风最致命的形式是脑出血。虽然有些治疗方法可能有帮助，但它们也有副作用，我们不知道哪些人会从这些治疗中获益多于坏处。该提案将建立一种使用CT扫描和血液测试来决定谁将从哪种治疗中受益的方法。

项目成果

CT Angiography Spot Sign, Hematoma Expansion, and Outcome in Primary Pontine Intracerebral Hemorrhage.

• DOI: 10.1007/s12028-016-0241-2
• 发表时间: 2016-08
• 期刊: Neurocritical care
• 影响因子: 3.5
• 作者: Morotti A;Jessel MJ;Brouwers HB;Falcone GJ;Schwab K;Ayres AM;Vashkevich A;Anderson CD;Viswanathan A;Greenberg SM;Gurol ME;Romero JM;Rosand J;Goldstein JN
• 通讯作者: Goldstein JN

Predictors of hematoma volume in deep and lobar supratentorial intracerebral hemorrhage.

• DOI: 10.1001/jamaneurol.2013.98
• 发表时间: 2013-08
• 期刊: JAMA NEUROLOGY
• 影响因子: 29
• 作者: Falcone, Guido J.;Biffi, Alessandro;Brouwers, H. Bart;Anderson, Christopher D.;Battey, Thomas W. K.;Ayres, Alison M.;Vashkevich, Anastasia;Schwab, Kristin;Rost, Natalia S.;Goldstein, Joshua N.;Viswanathan, Anand;Greenberg, Steven M.;Rosand, Jonathan
• 通讯作者: Rosand, Jonathan

Should anticoagulation be resumed after intracerebral hemorrhage?

• DOI: 10.3949/ccjm.77a.10018
• 发表时间: 2010-11
• 期刊: Cleveland Clinic journal of medicine
• 影响因子: 6.1
• 作者: Goldstein JN;Greenberg SM
• 通讯作者: Greenberg SM

Critical care management of acute intracerebral hemorrhage.

急性脑出血的重症监护管理。

• DOI: 10.1007/s11940-010-0109-2
• 发表时间: 2011
• 期刊: Current treatment options in neurology
• 影响因子: 2
• 作者: Goldstein,JoshuaN;Gilson,AaronJ
• 通讯作者: Gilson,AaronJ

Cost and Utility of Microbiological Cultures Early After Intensive Care Unit Admission for Intracerebral Hemorrhage.

• DOI: 10.1007/s12028-016-0285-3
• 发表时间: 2017-03
• 期刊: Neurocritical care
• 影响因子: 3.5
• 作者: Elmer J;Yamane D;Hou PC;Wilcox SR;Bajwa EK;Hess DR;Camargo CA Jr;Greenberg SM;Rosand J;Pallin DJ;Goldstein JN;Takhar SS
• 通讯作者: Takhar SS