Neeraj S Naval1, Robert G Kowalski2, Tiffany R Chang2, Filissa Caserta2, J Ricardo Carhuapoma3, Rafael J Tamargo4. 1. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: nnaval1@jhmi.edu. 2. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 4. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
BACKGROUND: The Hunt and Hess grade and World Federation of Neurological Surgeons (WFNS) scale are commonly used to predict mortality after aneurysmal subarachnoid hemorrhage (aSAH). Our objective was to improve the accuracy of mortality prediction compared with the aforementioned scales by creating the "SAH score." METHODS: The aSAH database at our institution was analyzed for factors affecting in-hospital mortality using multiple logistic regression analysis. Scores were weighted based on relative risk of mortality after stratification of each of these variables. Glasgow Coma Scale (GCS) was subdivided into groups of 3-4 (score = 1), 5-8 (score = 2), 9-13 (score = 3), and 14-15 (score = 4). Age was categorized into 4 subgroups: 18-49 (score = 1), 50-69 (score = 2), 70-79 (score = 3), and 80 years or more (score = 4). Medical comorbidities were subdivided into none (score = 1), 1 (score = 2), or 2 or more (score = 3). RESULTS: In total, 1134 patients were included; all-cause SAH hospital mortality was 18.3%. Admission GCS, age, and medical comorbidities significantly affected mortality after multivariate analysis (P < .05). Summated scores ranged from 0 to 8 with escalating mortality at higher scores (0 = 2%, 1 = 6%, 2 = 8%, 3 = 15%, 4 = 30%, 5 = 58%, 6 = 79%, 7 = 87%, and 8 = 100%). Positive predictive value (PPV) for scores in the range 7-8 was 88.5%, whereas 6-8 was 83%. Negative predictive value (NPV) was 94% for range 0-2 and 92% for 0-3. The area under the curve (AUC) for the SAH score was .821 (good accuracy), compared with the WFNS scale (AUC .777, fair accuracy) and the Hunt and Hess grade (AUC .771, fair accuracy). CONCLUSIONS: The SAH score was found to be more accurate in predicting aSAH mortality compared with the Hunt and Hess grade and WFNS scale.
BACKGROUND: The Hunt and Hess grade and World Federation of Neurological Surgeons (WFNS) scale are commonly used to predict mortality after aneurysmal subarachnoid hemorrhage (aSAH). Our objective was to improve the accuracy of mortality prediction compared with the aforementioned scales by creating the "SAH score." METHODS: The aSAH database at our institution was analyzed for factors affecting in-hospital mortality using multiple logistic regression analysis. Scores were weighted based on relative risk of mortality after stratification of each of these variables. Glasgow Coma Scale (GCS) was subdivided into groups of 3-4 (score = 1), 5-8 (score = 2), 9-13 (score = 3), and 14-15 (score = 4). Age was categorized into 4 subgroups: 18-49 (score = 1), 50-69 (score = 2), 70-79 (score = 3), and 80 years or more (score = 4). Medical comorbidities were subdivided into none (score = 1), 1 (score = 2), or 2 or more (score = 3). RESULTS: In total, 1134 patients were included; all-cause SAH hospital mortality was 18.3%. Admission GCS, age, and medical comorbidities significantly affected mortality after multivariate analysis (P < .05). Summated scores ranged from 0 to 8 with escalating mortality at higher scores (0 = 2%, 1 = 6%, 2 = 8%, 3 = 15%, 4 = 30%, 5 = 58%, 6 = 79%, 7 = 87%, and 8 = 100%). Positive predictive value (PPV) for scores in the range 7-8 was 88.5%, whereas 6-8 was 83%. Negative predictive value (NPV) was 94% for range 0-2 and 92% for 0-3. The area under the curve (AUC) for the SAH score was .821 (good accuracy), compared with the WFNS scale (AUC .777, fair accuracy) and the Hunt and Hess grade (AUC .771, fair accuracy). CONCLUSIONS: The SAH score was found to be more accurate in predicting aSAH mortality compared with the Hunt and Hess grade and WFNS scale.
Authors: Daniel W Zumofen; Michel Roethlisberger; Rita Achermann; Schatlo Bawarjan; Martin N Stienen; Christian Fung; Donato D'Alonzo; Nicolai Maldaner; Andrea Ferrari; Marco V Corniola; Daniel Schoeni; Johannes Goldberg; Daniele Valsecchi; Thomas Robert; Rodolfo Maduri; Martin Seule; Jan-Karl Burkhardt; Serge Marbacher; Philippe Bijlenga; Kristine A Blackham; Heiner C Bucher; Luigi Mariani; Raphael Guzman Journal: Neurosurg Rev Date: 2018-02-10 Impact factor: 3.042
Authors: James Feghali; Jennifer Kim; Abhishek Gami; Sarah Rapaport; Justin M Caplan; Cameron G McDougall; Judy Huang; Rafael J Tamargo; Christopher M Jackson Journal: Neurosurg Rev Date: 2021-04-10 Impact factor: 3.042
Authors: H Alex Choi; Andres Fernandez; Sang-Beom Jeon; J Michael Schmidt; E Sander Connolly; Stephan A Mayer; Jan Claassen; Neeraj Badjatia; Kenneth M Prager; Kiwon Lee Journal: Neurocrit Care Date: 2015-06 Impact factor: 3.210
Authors: Jude P J Savarraj; Georgene W Hergenroeder; Liang Zhu; Tiffany Chang; Soojin Park; Murad Megjhani; Farhaan S Vahidy; Zhongming Zhao; Ryan S Kitagawa; H Alex Choi Journal: Neurology Date: 2020-11-12 Impact factor: 9.910
Authors: Dannys Rivero Rodríguez; Claudio Scherle Matamoros; Leda Fernández Cúe; Jose Luis Miranda Hernández; Yanelis Pernas Sánchez; Jesús Pérez Nellar Journal: Neurol Res Int Date: 2015-02-05
Authors: Ju Young Hong; Je Sung You; Min Joung Kim; Hye Sun Lee; Yoo Seok Park; Sung Phil Chung; Incheol Park Journal: BMJ Open Date: 2019-02-20 Impact factor: 2.692
Authors: Katja E Wartenberg; David Y Hwang; Karl Georg Haeusler; Susanne Muehlschlegel; Oliver W Sakowitz; Dominik Madžar; Hajo M Hamer; Alejandro A Rabinstein; David M Greer; J Claude Hemphill; Juergen Meixensberger; Panayiotis N Varelas Journal: Neurocrit Care Date: 2019-10 Impact factor: 3.210