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.

描述（由申请人提供）： 项目摘要：Goldstein 博士是一名急诊科医生，其长期目标是改善神经急症患者的护理。脑出血 (ICH) 是最致命的中风形式，目前尚无经过验证的治疗方法。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于改善预后至关重要。床边扩张预测器将允许急性治疗专门针对那些可能受益的患者，同时使那些不会发生扩张的患者免受此类疗法的副作用。 Goldstein 博士在基础和临床研究方面拥有坚实的基础，并在两位国家级 ICH 和急诊医学专家的指导下寻求研究方法和师资发展方面的进一步培训。博士。格林伯格和卡马戈拥有独立的外部资助以及指导已发展成为积极的临床研究人员的临床医生的记录。该提案包括神经病学、神经放射学、急诊医学和生物统计学方面临床专家的紧密结合。这项针对急性脑出血患者的前瞻性观察研究的目的如下： 1) 确定 CT 血管造影 (CTA) 上显示的造影剂外渗是否可以预测随后的血肿扩张； 2) 确定造影剂外渗是否独立预测不良的长期结果； 3) 确定急性环境下的血清生物标志物是否可以预测血肿扩大； 4）制定可用于敏锐指导治疗的预测规则； 5) 获得神经放射学和使用成像对患者进行紧急风险分层的正式培训； 6) 通过哈佛大学公共卫生学院的硕士学位课程获得生物统计学和流行病学方面的正式培训。该提案将为未来指导有血肿扩大风险的患者进行急性治疗的试验奠定基础。这笔培训补助金将为戈德斯坦博士转变为一名独立的临床科学家提供关键支持，该科学家在神经系统紧急情况下进行以患者为导向的研究。相关性：最致命的中风是脑部出血。虽然一些治疗方法可能有帮助，但它们也有副作用，我们不知道哪些人从这些疗法中获益大于伤害。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

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

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

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

Ischemic-appearing electrocardiographic changes predict myocardial injury in patients with intracerebral hemorrhage.

缺血性心电图变化可预测脑出血患者的心肌损伤。

• DOI: 10.1016/j.ajem.2011.02.007
• 发表时间: 2012
• 期刊: The American journal of emergency medicine
• 作者: Hasegawa,Kohei;Fix,MeganL;Wendell,Lauren;Schwab,Kristin;Ay,Hakan;Smith,EricE;Greenberg,StevenM;Rosand,Jonathan;Goldstein,JoshuaN;Brown,DavidFM
• 通讯作者: Brown,DavidFM