Prediction of outcome after subarachnoid hemorrhage: timing of clinical assessment.

@article{vanDonkelaar2017PredictionOO,
  title={Prediction of outcome after subarachnoid hemorrhage: timing of clinical assessment.},
  author={Carlina E. van Donkelaar and Nicolaas A. Bakker and Nic J.G.M. Veeger and Maarten Uyttenboogaart and Jan D. M. Metzemaekers and Omid S Eshghi and Aryan Mazuri and Mahrouz Foumani and Gert-Jan Luijckx and Rob J. M. Groen and J. Marc C. van Dijk},
  journal={Journal of neurosurgery},
  year={2017},
  volume={126 1},
  pages={
          52-59
        }
}
OBJECTIVE Currently, early prediction of outcome after spontaneous subarachnoid hemorrhage (SAH) lacks accuracy despite multiple studies addressing this issue. The clinical condition of the patient on admission as assessed using the World Federation of Neurosurgical Societies (WFNS) grading scale is currently considered the gold standard. However, the timing of the clinical assessment is subject to debate, as is the contribution of additional predictors. The aim of this study was to identify… 

Figures and Tables from this paper

Prediction of Outcome After Aneurysmal Subarachnoid Hemorrhage: Development and Validation of the SAFIRE Grading Scale

The SAFIRE grading scale is an accurate, generalizable, and easily applicable model for early prediction of clinical outcome after aneurysmal subarachnoid hemorrhage (aSAH).

Time course of outcome in poor grade subarachnoid hemorrhage patients: a longitudinal retrospective study

Both hospital mortality and UO remained high in poor grade SAH patients and patients with WFNS 5 on admission had worse prognosis than others; this should be taken into consideration for future clinical studies.

Assessment of the Subarachnoid Hemorrhage International Trialists (SAHIT) Models for Dichotomized Long-Term Functional Outcome Prediction After Aneurysmal Subarachnoid Hemorrhage in a United Kingdom Multicenter Cohort Study.

The SAHIT prediction models, incorporating simple factors available on hospital admission, show good predictive performance for long-term functional outcome after aneurysmal subarachnoid hemorrhage.

Impact of Age On Short-Term Outcomes After Discharge in Patients With Aneurysmal Subarachnoid Hemorrhage

Mild neurological grade on admission and no cerebral infarction due to cerebral vasospasm were the factors improving outcomes, and aging was a factor declining outcomes between discharge and at 3 months after onset.

The influence of nimodipine and vasopressors on outcome in patients with delayed cerebral ischemia after spontaneous subarachnoid hemorrhage.

It seems encouraging that a maximum nimodipine dosage can be achieved despite the need for a higher vasopressor dose in patients with SAH, and higher doses of vasopressors can safely provide a situation in which the maximum dose of nimmodipine could be administered.

Assessing Contribution of Higher Order Clinical Risk Factors to Prediction of Outcome in Aneurysmal Subarachnoid Hemorrhage Patients

The preliminary findings indicate the proposed model has the potential to aid treatment decisions and effective imaging resource utilization in high-risk patients by providing actionable predictions prior to the development of neurological deterioration.

References

SHOWING 1-10 OF 26 REFERENCES

Toward more rational prediction of outcome in patients with high-grade subarachnoid hemorrhage.

Timing of grading is an important factor in outcome prediction that needs to be standardized, especially when the patient is assessed using the WFNS scale or the GCS, and this study suggests that the patient's worst clinical grade is most predictive of outcome.

Predictors of excellent functional outcome in aneurysmal subarachnoid hemorrhage.

The likelihood of excellent outcome is predicted by good clinical condition after resuscitation, absence of ICH on presentation, no evidence of infarction on brain imaging, and absence of blood transfusion during hospitalization.

Clinical Prediction Models for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review

While clinical prediction models for aSAH use a few simple predictors, there are substantial methodological problems with the models and none have had external validation, which precludes the use of existing models for clinical or research purposes.

External ventricular drainage response in poor grade aneurysmal subarachnoid hemorrhage: effect on preoperative grading and prognosis

Long-term outcomes in poor grade patients who improve after EVD placement are similar to patients with lower grade hemorrhages, with a higher incidence of favorable outcome than pre-EVD controls.

Cognitive Functioning and Health-Related Quality of Life 1 Year After Aneurysmal Subarachnoid Hemorrhage in Preoperative Comatose Patients

A dilemma remains regarding treatment of a comatose patient where, on one hand, the outcome may be extremely poor despite enormous treatment efforts and, on the other hand, a more passive attitude toward aggressive treatment may withhold a potentially good outcome.

The prognostic significance of intracerebral haematoma as shown on CT scanning after aneurysmal subarachnoid haemorrhage.

In a prospective study of 1076 consecutive patients with aneurysmal subarachnoid haemorrhage (SAH), CT was carried out and CT visible intracerebral haematoma (ICH) was found, indicating that the acute brain dysfunction from SAH complicated by ICH is more likely to be followed by permanent cerebral damage.

Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage: Rebleeding Aneurysmal Subarachnoid Hemorrhage Study

Timing of treatment of aSAH patients, especially those with an modified Fisher grade of 3 or 4 in a good clinical condition, should be reconsidered and provoke the debate on timing of aneurysm repair, especially in patients considered to be at high risk for rebleeding.

Amount of Blood on Computed Tomography as an Independent Predictor After Aneurysm Rupture

The total amount of subarachnoid blood on the initial computed tomogram has independent predictive power for the occurrence of delayed cerebral ischemia.

Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale.

The modified Fisher scale, which accounts for thick cisternal and ventricular blood, predicts symptomatic vasospasm after subarachnoid hemorrhage more accurately than original Fisher scale.