Introduction: The purpose of this study is to analyze the prognostic significance of clinical and radiologic factors during hospitalization for subarachnoid hemorrhage (SAH). Based on these factors, we propose a 4-variable, readily usable scoring system that is highly predictive of long-term neurological functional outcomes after hospitalization for SAH.
Methods: We conducted a retrospective review of patients with aneurysmal subarachnoid hemorrhage surviving to discharge in a single academic institution in the period of 2007-2016. A comparison analysis was then performed on these patients based on unfavorable functional outcomes (modified Rankin Scale scores 2-6) at follow-up 6 to 12 months. 128 patients were included in the analysis; 99 patients (77.3%) had a good outcome and 29 (22.7%) had a bad outcome. 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 bad outcomes at 6-12 months.
Results: Based on the results of multivariate analysis, our new score for predicting outcomes, which ranges from 0 to 4, was tested in our cohort. The following parameters were included: Hunt & Hess score of 4-5, re-bleeding, infarction after 48 hours and clinically relevant infection. The presence of each parameter yielded 1 point. Our model had an ROC area under the curve of 79.8% for detecting bad outcomes (mRS 2-6 at 6-12 months), which was better than BNI (64.4%) and WFNS (56.9%). A higher score had an OR 3.81 (CI 95%: 2.14 – 6.77; p<0.01) for predicting bad outcomes.
Conclusions: Here we propose a four-variable grading system to predict long-term functional outcomes in patients with subarachnoid hemorrhage surviving hospitalization. Our data suggest that patients with lower scores may have better long-term functional outcomes. Our scale is usable before patient discharge to aid in patient and family expectation guidance and long-term care planning.
Patient Care: It will provide a scoring system for prediction of long-term neurologic outcomes in patients with aSAH.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of prediction of long-term outcomes in patients with aneurysmal SAH, 2) Discuss, in small groups, which factors may be most closely correlated with long-term neurologic outcomes, 3) Identify an effective scoring system to predict such outcomes.