Predictors of hematoma expansion in acute intracerebral hemorrhage

描述(由申请人提供)：项目摘要：戈尔茨坦博士是一名急诊医生，长期目标是改善神经急症患者的护理。脑出血(ICH)是中风最致命的形式，目前还没有经过验证的治疗方法。血肿扩大是这种疾病最可怕的并发症，针对这种扩大的治疗可能是改善预后的关键。床边的扩张预测指标将使急性疗法能够专门针对那些可能受益的患者，同时使那些不会出现扩张的患者免受此类疗法的副作用。戈尔茨坦博士在基础和临床研究方面拥有扎实的基础，并在两位全国公认的脑出血和急救医学专家的指导下，寻求在研究方法和师资发展方面的进一步培训。格林伯格博士和卡马戈博士在独立的外部资助和指导已发展为积极临床研究人员的临床医生方面有着良好的记录。这项建议包括将神经学、神经放射学、急诊医学和生物统计学的临床专家紧密结合起来。这项针对急性脑出血患者的前瞻性观察研究有以下目的：1)确定CT血管成像(CTA)上显示的对比剂外溢是否可预测随后的血肿扩大；2)确定对比剂外溢是否独立地预测不良的长期结果；3)确定急性期血清标记物是否可预测血肿的扩展；4)制定可用于准确指导治疗的预测规则；5)获得神经放射学的正式培训，并使用影像技术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的正式培训。该提案将为未来指导对有血肿扩大风险的患者进行急性治疗的试验奠定基础。这笔培训拨款将为戈尔茨坦博士转变为一名独立的临床科学家提供关键支持，他在神经学紧急情况下进行以患者为中心的研究。相关性：中风最致命的形式是脑部出血。虽然有些疗法可能有帮助，但它们也有副作用，我们不知道哪些人会从这些疗法中获得更多好处而不是伤害。这项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。

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.