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  • A novel, easy-to-use grading system for predicting mortality and functional outcome on discharge in patients with subarachnoid hemorrhage

    Final Number:

    Georgios Maragkos; Alejandro Enriquez-Marulanda; Mohamed Salem; Luis Ascanio; Kohei Chida; Raghav Gupta; Abdulrahman Alturki; Kimberly Kicielinski; Christopher Ogilvy; Justin Moore; Ajith Thomas

    Study Design:

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2018 Annual Meeting

    Introduction: Multiple grading systems have been proposed to predict outcomes for patients presenting with aneurysmal subarachnoid hemorrhage (aSAH), however, they may be difficult to use. The aim of our study is to provide a readily-usable, three-point prediction score, to gauge aSAH patient outcomes in the emergency setting.

    Methods: A retrospective review of patients with aSAH surviving to discharge in a single academic institution during 2007-2016 was conducted. A comparison analysis was performed on these patients based on unfavorable functional outcomes (modified Rankin Scale scores 2-6) at discharge. Variables that were significant in univariate analysis were then utilized to run a multivariate logistic regression and build a predictive model. The ROC curve was used to evaluate the discriminative performance of the model for unfavorable outcomes at discharge.

    Results: 280 patients were included in the analysis; 152 patients (54.3%) had a good outcome and 128 (45.7%) had an unfavorable outcome. Based on the results of multivariate analysis, the following parameters were selected: Glasgow Coma Scale of 3-8, age of 60 years or more and SAH thickness of 7 mm or more on CT scan. Each parameter yielded 1 point, with a total score of 0 to 3. Our model demonstrated an ROC area under the curve of 81.7% for detecting unfavorable outcome, which was better than Hunt and Hess (81.2%) and WFNS (77.9%). A higher score had an OR 2.77 (CI 95%: 2.18 – 3.54; p<0.01) for predicting bad outcomes.

    Conclusions: We are proposing a three-variable grading system to predict discharge mortality and functional outcomes in patients arriving at the emergency department with aSAH. Our scale is easily usable on patient admission and can help guide acute management planning and outcome expectations.

    Patient Care: We present a readily usable scale for outcome prognosis of aSAH patients on presentation, which may help with management planning and outcome expectations.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of stratifying patients presenting with aneurysmal SAH based on prognosis, 2) Discuss, in small groups,which factors may be predictive of outcome, 3) Identify an effective scoring system to quickly make that distinction


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