• Intracerebral hemorrhage (ICH) volume is a predictor of mortality and clinical outcome.
• Communicating ICH volume to neurosurgical and neurocritical care consultants can help direct treatment decisions.
• ICH volume can be estimated using the ABC/2 formula:
  • Select the CT slice with the largest area of the hemorrhage (reference slice)
  • A = Measure the largest diameter
  • B = Measure the largest diameter perpendicular to A
  • C = Multiply the number of CT slices with the hemorrhage by the slice thickness
    • Slices with 25-75% of the hematoma volume compared to the reference slice count as 1/2 slice
    • Slices with <25% of the hematoma volume compared to the reference slice do not count

• A recent study by Dsouza et al. found that EM attendings as well as EM trainees were reliable in estimating ICH volume using ABC/2 compared to radiologists.

Bottom Line:  EPs can reliably estimate ICH volume using the ABC/2 formula.  Communicating ICH volume to neurosurgical and neurocritical care consultants can help direct treatment decisions.

References

Dsouza LB, Pathan SA, Bhutta ZA, et al. ABC/2 estimation in intracerebral hemorrhage: A comparison study between emergency radiologists and emergency physicians. Am J Emerg Med. 2018 Dec 19. [Epub ahead of print]

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