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051 Systematic review of CT angiographic ‘spot sign’ for predicting mortality

Introduction To study whether presence of the CT angiographic ‘spot sign’ for spontaneous intracerebral haemorrhage (ICH) expansion is predictive of mortality. Method PubMed, Medline, conference proceedings and manuscript references up to June 2017 were searched for studies reporting “computed tomography angiography” and “spot sign” or “intracerebral haemorrhage” and “spot sign”. Positive (PLR) and negative (NLR) likelihood ratios were calculated using MetaDisc. The PLR needs to be ≥5 and NLR ≤0.1 for a test to be clinically useful. Results There have not been previous systematic reviews correlating the spot sign to clinical outcome. There were 36 studies describing 6888 patients and 32 clinical outcome measures. However, there were only three outcome measures with sufficient comparability across the studies. PLR, and NLR for in-hospital mortality by spot sign were 2.47 (95% CI 1.59–3.82) and 0.62 (95%CI 0.46–0.82) with a plateau of 2.7 and 0.6 respectively across 10 studies. PLR and NLR for 3 month mortality by haematoma expansion were 0.41 (95%CI 0.35–0.47) and 0.8 (95%CI 0.78–0.83) with a plateau of 2.0 and 0.8 respectively across 8 studies. Conclusion Overall, there is limited data available on clinical outcomes stratified by the ‘spot sign’. Based on the available information, the PLR and NLR did not meet respective thresholds of 5 and 0.1 required to have clinical utility.