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Background: Intracerebral hemorrhage (ICH) is a serious condition with high mortality and disability. Its incidence is rising, and management of supratentorial lesions remains debated. Prognostic scales, which incorporate hematoma volume, play a crucial role but can yield different outcomes based on small point variations. The widely used ABC/2 method for estimating hematoma volume may be inaccurate in some cases. This study compares manual volumetric assessment (MVA) with ABC/2 and evaluates their impact on prognostic scores.

Methods: We retrospectively analyzed clinical and radiological data of 100 patients with supratentorial ICH. Hematoma volumes were assessed using both ABC/2 and MVA methods and compared across three prognostic scales: ICH Score, SwICH Score, and Barlick Hospital Score. Statistical analyses were conducted to evaluate differences and prognostic implications.

Results: A statistically significant difference in hematoma volume was observed between ABC/2 and MVA (median 37.8 cm(3) [IQR 19.39-78.37] vs. 33.9 cm(3) [IQR 17.91-60.95]; p < 0.001). These differences led to discrepancies in prognostic classification across all scales. ROC curve analysis showed higher predictive accuracy for MVA over ABC/2 (AUC 0.739; 95 % CI: 0.640-0.838 vs. 0.690; 95 % CI: 0.585-0.795).

Conclusion: MVA appears more accurate than ABC/2 for hematoma volume estimation and may better predict patient outcomes. While prior assessments suggested ABC/2 inaccuracies were negligible, our findings indicate they can significantly affect prognostic classification. Further research is needed to validate these results.