Grading of subarachnoid hemorrhage: modification of the world World Federation of Neurosurgical Societies scale on the basis of data for a large series of patients.
OBJECTIVE
The goals of this study were to use a large, prospectively collected, multicenter database for patients with aneurysmal subarachnoid hemorrhage (SAH) who were treated between 1991 and 1997 to determine the prognostic significance of clinical and radiological factors for outcomes and to use those factors to develop a grading scale to predict outcomes.


METHODS
A total of 3567 patients with SAH who were entered into four randomized clinical trials of tirilazad were studied. Outcomes were assessed 3 months after SAH, with the Glasgow Outcome Scale. Twenty clinical and radiological factors were entered into univariate and multivariate analyses, to determine factors prognostic for outcomes. Grading scales based on the most powerful prognostic parameters were statistically derived and validated and were compared with the World Federation of Neurosurgical Societies (WFNS) grading scale.


RESULTS
Factors predictive of outcomes included age, WFNS grade, history of hypertension, systolic blood pressure at admission, ruptured aneurysm location and size, blood clot thickness on computed tomographic scans, and angiographic vasospasm at admission. A grading scale using these factors could be derived; it predicted outcomes more accurately than did the WFNS scale, although it would be more complex to use.


CONCLUSIONS
Outcome prediction after SAH can be improved by adding additional clinical and radiological factors to the WFNS scale, albeit with added complexity.
Rosen
David S
DS
Department of Surgery, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, Illinois 60637, USA.
Macdonald
R Loch
RL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000145:classification* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D003131:Combined Modality Therapy; D019992:Databases as Topic; D003952:Diagnostic Imaging; D004311:Double-Blind Method; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000145:classification* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use; D009493:Neurosurgery; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011281:Pregnatrienes / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012955:Societies, Medical; D013345:Subarachnoid Hemorrhage / Q000145:classification* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery
D018696:Neuroprotective Agents; D011281:Pregnatrienes; C053355:tirilazad