Accurate prediction of hematoma expansion (HE) in spontaneous intracerebral hemorrhage (sICH) is crucial for tailoring patient-specific treatments and improving outcomes. Recent advancements have yielded numerous HE risk factors and predictive models. This study aims to evaluate the characteristics and efficacy of existing HE prediction models, offering insights for performance enhancement.A comprehensive search was conducted in PubMed for observational studies and randomized controlled trials focusing on HE prediction, written in English. The prediction models were categorized based on their incorporated features and modeling methodology. Rigorous quality and bias assessments were performed. A meta-analysis of studies reporting C-statistics was executed to assess and compare the performance of current HE prediction models. Meta-regression was utilized to explore heterogeneity sources.From 358 initial records, 22 studies were deemed eligible, encompassing traditional models, hematoma imaging feature models, and models based on artificial intelligence or radiomics. Meta-analysis of 11 studies, involving 12,087 sICH patients, revealed an aggregated C-statistic of 0.74 (95% CI: 0.69-0.78) across seven HE prediction models. Eight characteristics related to development cohorts were identified as key factors contributing to performance variability among these models.The findings indicate that the current predictive capacity for HE risk remains suboptimal. Enhanced accuracy in HE prediction is vital for effectively targeting patient populations most likely to benefit from tailored treatment strategies.© 2024 S. Karger AG, Basel.