Multicenter Validation of the AVICH Score
Multicenter Validation of the AVICH Score
The primary objective of this multicenter study is to validate the AVICH score in terms of
 patient outcome prediction in AVM patients with associated ICH.

 Secondary objectives are the impact of pretreatment of the AVICH score. Patients outcome is
 measured using the modified Rankin Scale (mRS) and are grouped in favorable (mRS score, 0-2)
 and unfavourable (mRS score, 3-6) outcome at last follow-up (LFU). The following parameters,
 which are part of the AVICH score, will be compared between the 2 groups: ICH score including
 age, Glasgow Coma Scale (GCS) score, haemorrhage volume, presence of intraventricular
 hemorrhage (IVH), and localization of the ICH. Spetzler-Martin grade including AVM size,
 eloquent location, and venous drainage, as well as the Lawton-Young grade, including age,
 presence of ruptured AVM, and the nidus structure. In addition pre-/postruptured treatment
 modalities, including embolization, radiotherapy, surgery or no treatment will be analysed.
 Outcome (mRS) at 3 months, at 1 year, and at LFU will be compared.

 Multicentre validation study

 Key inclusion criteria:

 -  All patients with ICH associated AVMs and a modified Rankin Scale <2 (so 0-1) before
 hemorrhage

 -  Pretreatment (embolization, radiosurgery, surgery) before ICH is not an exclusion
 criteria.

 Key exclusion criteria:

 -  incomplete data set

 -  AVM Patients with only subarachnoid hemorrhage (SAH) or IVH and no ICH
Intracerebral hemorrhage (ICH) is the most common life threatening presentation of brain
 arteriovenous malformations (AVMs). Several AVM grading systems are available for presurgical
 risk assessment to help selecting patients for surgery. The most widely accepted and classic
 grading system is the Spetzler-Martin grading system; however, the recently introduced and
 externally validated supplemented Spetzler-Martin system seems to have an even better
 predictive accuracy. The pathophysiology of AVM-related ICH and spontaneous ICH is completely
 different. It is well known that clinical outcome in patients suffering spontaneous ICH is
 worse compared with patient outcome after AVM-related ICH. For spontaneous ICH, not related
 to AVM, several scoring systems exist to predict patient outcome. The most commonly used
 system is the ICH score. The available ICH scoring systems may not predict outcome in
 patients with hemorrhage caused by AVM rupture with the highest accuracy possible. Therefore,
 we examined a new scoring system called the AVM-related ICH score (AVICH score), which
 predicts patient outcome in the acute setting of AVM rupture. This scoring system is a
 special adaptation of the supplemented Spetzler-Martin grading system designed for patients
 presenting with hemorrhage, which includes additional clinical and radiographic information.
 Based on the area under the receiver operating characteristics curve (AUROC) analysis in this
 single center analysis, the AVICH score predicts outcome of patients with ruptured AVM and
 associated ICH better than the ICH score, the Spetzler-Martin, or the supplemented
 Spetzler-Martin grading system. An external validation is needed before the AVICH score is
 tested in a prospective multicenter cohort.

 The primary objective of this multicenter study is to validate the AVICH score in terms of
 patient outcome prediction in AVM patients with associated ICH.

 Secondary objectives are the impact of pretreatment of the AVICH score. Patients outcome is
 measured using the modified Rankin Scale (mRS) and are grouped in favorable (mRS score, 0-2)
 and unfavourable (mRS score, 3-6) outcome at last follow-up (LFU). The following parameters,
 which are part of the AVICH score, will be compared between the 2 groups: ICH score including
 age, Glasgow Coma Scale (GCS) score, haemorrhage volume, presence of intraventricular
 hemorrhage (IVH), and localization of the ICH. Spetzler-Martin grade including AVM size,
 eloquent location, and venous drainage, as well as the Lawton-Young grade, including age,
 presence of ruptured AVM, and the nidus structure. In addition pre-/postruptured treatment
 modalities, including embolization, radiotherapy, surgery or no treatment will be analysed.
 Outcome (mRS) at 3 months, at 1 year, and at LFU will be compared.

 Key inclusion criteria:

 -  All patients with ICH associated AVMs and a modified Rankin Scale <2 (so 0-1) before
 hemorrhage

 -  Pretreatment (embolization, radiosurgery, surgery) before ICH is not an exclusion
 criteria.

 Key exclusion criteria:

 -  incomplete data set

 -  AVM Patients with only SAH or IVH and no ICH

 September, 1, 2016 - September, 30, 2016

 -  individual ethical approval each center (if needed)

 -  data collection (n = approximately 30/center)

 November, 1, 2016 - November, 31, 2016

 - data analysis (Zurich)
Inclusion Criteria:

 -  All patients with ICH associated AVMs and a modified Rankin Scale <2 (so 0-1) before
 hemorrhage

 -  Pretreatment (embolization, radiosurgery, surgery) before ICH is not an exclusion
 criteria.

 Exclusion Criteria:

 -  incomplete data set

 -  AVM Patients with only SAH or IVH and no ICH