Measure IVH GRAEB Scale Quantitative analysis of blood

Measure IVH: GRAEB Scale • Quantitative analysis of blood in the ventricular system • Prediction of outcome 1 • Track clot resolution for dosing decisions • Monitor for new blood (re-bleed) vs. clot migration 1 Graeb DA, Robertson WD, Lapointe JS, Nugent RA, Harrison PB. Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis. Radiology. 1982 pr; 143(1): 91 -6.

Modified Graeb Scoring R Temporal Tip L Temporal Tip IIIrd R Lat L Lat • Scores: • R Temporal Tip: _____ • R Lateral: _____ • R Posterior Tip: _____ • L Temporal Tip: _____ • L Lateral: _____ • L Posterior Tip: _____ • IIIrd: _____ • IVth: _____ • • Sum each column: _____ • Total Score: Enter “ 1” if Expanded IVth R Posterior Tip L Posterior Tip _____

Anatomy of the ventricular system Lateral Ventricle Posterior Tip Trigone Third Ventricle Temporal Tip Fourth Ventricle

The Graeb score from a CT, the old way

The Graeb score from a CT (using the e. CRF) • Fill out ventricle diagram to correspond with the amount and location of blood observed in the CT scan by clicking on the online form.

Rules for standardization IVH GRADING SCALE 1. Add one point for each ventricle that is expanded beyond normal anatomic limits. This only applies to ventricles filled with blood. 2. Use the trigone as the boundary to differentiate the lateral ventricle, posterior tip, and temporal tip. 3. Round upwards – for example, if you believe that 40 - 60% of a ventricle is occupied by blood, the ventricle is graded as >50% occupied. The minimum point total is 0 (i. e. , no blood); the maximum point total is 32 (i. e. , completely full of blood with maximum expansion).

Example Subject, Stability Scan Fourth Ventricle (corresponding score) Scores: Enter “ 1” if Expanded R Temporal Tip: _____ R Lat: _____ R Posterior Tip: _____ L Temporal Tip: _____ L Lat: _____ L Posterior Tip: _____ IIIrd: _____ IVth: _____ Sum each column: _____ Total Score: 4 1 _____

Example Subject, Stability Scan Left Temporal Tip (corresponding score) Scores: Enter “ 1” if Expanded R Temporal Tip: _____ R Lat: _____ R Posterior Tip: _____ L Temporal Tip: _____ L Lat: _____ L Posterior Tip: _____ IIIrd: _____ IVth: _____ Sum each column: _____ Total Score: 1 0 4 1 _____

Example Subject, Stability Scan Right Temporal Tip (corresponding score) Scores: Enter “ 1” if Expanded 1 0 R Temporal Tip: _____ R Lat: _____ R Posterior Tip: _____ L Temporal Tip: _____ L Lat: _____ L Posterior Tip: _____ IIIrd: _____ IVth: _____ Sum each column: _____ Total Score: 1 0 4 1 _____

Example Subject, Stability Scan Left Posterior Tip (corresponding score) Scores: Enter “ 1” if Expanded 1 0 R Temporal Tip: _____ R Lat: _____ R Posterior Tip: _____ L Temporal Tip: _____ L Lat: _____ L Posterior Tip: ____ 2 _____ IIIrd: _____ IVth: _____ Sum each column: _____ Total Score: 1 0 0 4 1 _____

Example Subject, Stability Scan Right Posterior Tip (corresponding score) Scores: Enter “ 1” if Expanded 1 0 R Temporal Tip: _____ R Lat: _____ R Posterior Tip: _____ L Temporal Tip: 2 1 ____ L Lat: _____ L Posterior Tip: ____ 2 _____ IIIrd: _____ IVth: _____ Sum each column: _____ Total Score: 0 0 _____ 0 4 1 _____

Example Subject, Stability Scan Third Ventricle (corresponding score) Scores: Enter “ 1” if Expanded 1 0 R Temporal Tip: _____ R Lat: _____ R Posterior Tip: _____ L Temporal Tip: 2 1 ____ L Lat: _____ L Posterior Tip: _____ IVth: 2 4 ____ Sum each column: _____ IIIrd: Total Score: 0 0 _____ 0 1 _____

Example Subject, Stability Scan Right, Left Laterals (corresponding score) Scores: Enter “ 1” if Expanded _____ IVth: 1 4 ____ 2 ____ 1 ____ 3 ____ 2 ____ 4 ____ Sum each column: _____ R Temporal Tip: R Lat: R Posterior Tip: L Temporal Tip: L Lat: L Posterior Tip: IIIrd: Total Score: 0 0 _____ 0 _____ 1 _____

Example Subject, Stability Scan 3 D Reconstruction (IVH only) (corresponding score) Scores: Enter “ 1” if IVth: 1 4 ____ 2 ____ 1 ____ 3 ____ 2 ____ 4 ____ Sum each column: ____ R Temporal Tip: R Lat: R Posterior Tip: L Temporal Tip: L Lat: L Posterior Tip: IIIrd: Total Score: Expanded 0 0 _____ 0 _____ 1 _____ 21 _____ 2 23 _____

GRAEB Best Practices • Use scores in dosing decision making. • Complete your scores in real-time. • Have PI and coordinator complete paper forms together. Then make every attempt to make the numbers reflect the actual score when clicking the online form. • Be consistent with your boundaries from scan to scan, patient to patient. • Compare your subject’s current scan with their most recent previous scan to evaluate changes.