RATIONALE AND OBJECTIVES: The purpose is to perform outcomes-based assessment of a new reference standard for delayed cerebral ischemia (DCI) related to vasospasm. MATERIALS AND METHODS: Retrospective study was performed with consecutive aneurysmal subarachnoid hemorrhage (A-SAH) patients between January 2002 and May 2009. A new reference standard for DCI was applied to the study population incorporating clinical and imaging criteria. Diagnostic accuracy was determined by chart diagnosis. Outcome measures for assessment included: permanent neurologic deficits, infarction, functional disability, treatment, and discharge status. Medical record review was performed by two blinded observers. Chi-square test calculated statistical significance between DCI and no DCI groups. RESULTS: A total of 137 patients were included; 59% (81/137) classified as DCI and 41% (56/137) as no DCI by the reference standard. Overall accuracy is 96% (95% confidence interval 92-99) with 100% sensitivity, 92% specificity, 94% positive and 100% negative predictive values. Patients classified as DCI had 40% (32/81) permanent neurologic deficits and 57% (46/81) infarction compared to 0% (0/56) classified as no DCI. DCI patients had 33% (27/81) functional disability compared to 13% (7/56) classified as no DCI. Ninety-four percent (76/81) DCI patients received treatment compared to 0% (0/56) classified as no DCI. DCI group had 46% (37/81) discharged to rehabilitation facilities and 11% (9/81) mortality compared to 25% (14/56) and 2% (1/56), respectively, in no DCI group. There are statistically significant differences (P < .0001) between DCI and no DCI groups for all outcome measures. CONCLUSION: This new reference standard has high diagnostic accuracy for DCI related to vasospasm. The outcomes-based assessment further supports its accuracy in correctly classifying A-SAH patients.
RATIONALE AND OBJECTIVES: The purpose is to perform outcomes-based assessment of a new reference standard for delayed cerebral ischemia (DCI) related to vasospasm. MATERIALS AND METHODS: Retrospective study was performed with consecutive aneurysmal subarachnoid hemorrhage (A-SAH) patients between January 2002 and May 2009. A new reference standard for DCI was applied to the study population incorporating clinical and imaging criteria. Diagnostic accuracy was determined by chart diagnosis. Outcome measures for assessment included: permanent neurologic deficits, infarction, functional disability, treatment, and discharge status. Medical record review was performed by two blinded observers. Chi-square test calculated statistical significance between DCI and no DCI groups. RESULTS: A total of 137 patients were included; 59% (81/137) classified as DCI and 41% (56/137) as no DCI by the reference standard. Overall accuracy is 96% (95% confidence interval 92-99) with 100% sensitivity, 92% specificity, 94% positive and 100% negative predictive values. Patients classified as DCI had 40% (32/81) permanent neurologic deficits and 57% (46/81) infarction compared to 0% (0/56) classified as no DCI. DCIpatients had 33% (27/81) functional disability compared to 13% (7/56) classified as no DCI. Ninety-four percent (76/81) DCIpatients received treatment compared to 0% (0/56) classified as no DCI. DCI group had 46% (37/81) discharged to rehabilitation facilities and 11% (9/81) mortality compared to 25% (14/56) and 2% (1/56), respectively, in no DCI group. There are statistically significant differences (P < .0001) between DCI and no DCI groups for all outcome measures. CONCLUSION: This new reference standard has high diagnostic accuracy for DCI related to vasospasm. The outcomes-based assessment further supports its accuracy in correctly classifying A-SAHpatients.
Authors: Mervyn D I Vergouwen; Marinus Vermeulen; Jan van Gijn; Gabriel J E Rinkel; Eelco F Wijdicks; J Paul Muizelaar; A David Mendelow; Seppo Juvela; Howard Yonas; Karel G Terbrugge; R Loch Macdonald; Michael N Diringer; Joseph P Broderick; Jens P Dreier; Yvo B W E M Roos Journal: Stroke Date: 2010-08-26 Impact factor: 7.914
Authors: Jennifer A Frontera; Andres Fernandez; J Michael Schmidt; Jan Claassen; Katja E Wartenberg; Neeraj Badjatia; E Sander Connolly; Stephan A Mayer Journal: Stroke Date: 2009-04-09 Impact factor: 7.914
Authors: Jose I Suarez; Adnan I Qureshi; Abutaher B Yahia; Parak D Parekh; Rafael J Tamargo; Michael A Williams; John A Ulatowski; Daniel F Hanley; Alexander Y Razumovsky Journal: Crit Care Med Date: 2002-06 Impact factor: 7.598
Authors: J Ivanidze; K Kesavabhotla; O N Kallas; D Mir; H Baradaran; A Gupta; A Z Segal; J Claassen; P C Sanelli Journal: AJNR Am J Neuroradiol Date: 2015-01-08 Impact factor: 3.825