Hemostasis, Hematoma Expansion, and Outcomes After Intracerebral Hemorrhage

脑出血后的止血、血肿扩张和结果

• 批准号: 10598712
• 负责人: ANDREW M NAIDECH
• 金额: $ 30.01万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10598712
• 关键词: Accountability; Acute; Acute Disease; Address; Affect; Aging; Algorithms; American; Americas; Anticoagulants; Artificial Intelligence; Award; Biological Markers; Blood coagulation; Brain; Caregivers; Caring; Catchment Area; Cerebral hemisphere hemorrhage; Cessation of life; Clinical; Clinical Data; Consumption; Data; Data Set; Data Sources; Decision Making; Development; Diagnosis; Diagnostic; Disease; Disease model; Electronic Health Record; Ethical Issues; Ethics; Ethnic Origin; Event; Exposure to; Family member; Fever; Fright; Future; Gastrostomy; Geography; Growth; Hand; Health; Hematoma; Hemorrhage; Hemostatic Agents; Hemostatic function; Hour; Hypertension; Informatics; Ingestion; Interview; Lead; Life; Location; Machine Learning; Measures; Medical; Methods; Minority; Modeling; Myocardial Infarction; Neurology; Nurses; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Performance; Pharmaceutical Preparations; Pharmacists; Physicians; Population Heterogeneity; Prevalence; Process; Qualitative Research; ROC Curve; Race; Recommendation; Research; Resources; Rural; Savings; Scanning; Seizures; Severities; Status Epilepticus; Stroke; Structure; Symptoms; Testing; Therapeutic; Thrombosis; Time; Training; Travel; Treatment outcome; Trust; United States National Institutes of Health; Vascular Diseases; Vulnerable Populations; Work; X-Ray Computed Tomography; adverse event risk; artificial intelligence algorithm; base; brain tissue; clinical practice; clopidogrel; cranium; disability; diverse data; follow-up; health care availability; health care service; health related quality of life; high risk; model development; neuroimaging; patient population; prediction algorithm; prevent; prothrombin complex concentrates; racial difference; risk minimization; rural area; sex; side effect; suburb

PROJECT SUMMARY Intracerebral hemorrhage (ICH), bleeding into brain tissue, is often disabling or deadly. Complications of ICH compound the impact on patient outcome. Hematoma expansion is growth of the hematoma from the first (diagnostic) computed tomography (CT) scan to a follow-up CT scan, and occurs in 10-25% of patients. Reducing hematoma expansion reduces death and disability by keeping small hematomas small. Otherwise, hematoma expansion will compress brain tissue in the limited space in the skull. Hemostatic medication (e.g., prothrombin complex concentrate) is effective in reducing hematoma expansion in patients at high risk for hematoma expansion. However, our ability to predict hematoma expansion and select patients for hemostatic medication is limited. Unfortunately, hemostatic medication has potential side effects, such as myocardial infarction. Separately, seizures occur in about 10% of patients and may progress to status epilepticus (continual seizures). Unfortunately, a practice of widespread seizure medications also leads to complications, worse patient outcomes, and reduced health-related quality of life at follow-up. Patient care is harmed because we cannot select patients for potentially life-saving treatments (hemostatic treatment, seizure medications). ML/AI provide a solution to these roadblocks. We have developed ML/AI algorithms to solve these roadblocks of targeting hemostatic treatment and seizure medications in the context of an ongoing award to predict hematoma expansion using ML of multiple measures of blood clotting (biomarkers of hemostasis). However, significant ethical issues remain unresolved. ML/AI algorithms may be subject to unforeseen bias in the patient populations from which they are developed. Bias may lead to different performance in patients considered vulnerable by the NIH (e.g., minority race, rural location, access to healthcare services). Previous qualitative interviews with clinicians (nurses, pharmacists, physicians) have revealed deep ambivalence about the use of ML/AI. There is excitement about consistent treatment recommendations and availability at all hours, but also concerns about bias, accountability, and oversight. Such qualitative research has not been performed in the setting of ICH, which requires emergent decision making because hematoma expansion and seizures occur within hours of ICH symptom onset. In the context of our ongoing award, we will determine if preliminary ML/AI algorithms we have developed have different performance in vulnerable patients; if needed, we will develop methods to correct it, assisted by diverse data sources in hand and established predictors of hematoma expansion and seizures. We will perform qualitative interviews with clinicians, patients, and family members affected by ICH to identify and address concerns that must be addressed if ML/AI is to be trusted in ICH. This proposal will serve as a model for other acute diseases that require emergent decision making.

项目总结

项目成果

P2Y12 inhibitor use predicts hematoma expansion in patients with intracerebral hemorrhage.

P2Y12 抑制剂的使用可预测脑出血患者的血肿扩大。

• DOI: 10.1002/acn3.52070
• 发表时间: 2024
• 期刊: Annals of clinical and translational neurology
• 影响因子: 5.3
• 作者: Houskamp,EthanJ;Liu,Yuzhe;SilvaPinheirodoNascimento,Juliana;Jahromi,BabakS;Lindholm,PaulF;Kwaan,HauC;Naidech,AndrewM
• 通讯作者: Naidech,AndrewM

From One-Size-Fits-All to Mechanism-Guided Treatment for Intracranial Hemorrhage.

从一刀切到机制引导的颅内出血治疗。

• DOI: 10.1097/ccm.0000000000004055
• 发表时间: 2019
• 期刊: Critical care medicine
• 影响因子: 8.8
• 作者: Naidech,AndrewM

The Story of Intracerebral Hemorrhage: From Recalcitrant to Treatable Disease.

• DOI: 10.1161/strokeaha.121.033484
• 发表时间: 2021-05
• 期刊: Stroke
• 影响因子: 8.3
• 作者: Broderick JP;Grotta JC;Naidech AM;Steiner T;Sprigg N;Toyoda K;Dowlatshahi D;Demchuk AM;Selim M;Mocco J;Mayer S
• 通讯作者: Mayer S