title: Preoperative prediction of outcome in 283 poor-grade patients with subarachnoid hemorrhage: a project of the Chugoku-Shikoku Division of the Japan Neurosurgical Society.
abstract: BACKGROUND
  The management of patients with poor-grade subarachnoid hemorrhage (SAH) continues to be controversial. The objective of this study was to examine predictors of outcome of poor-grade SAH after surgical obliteration of the aneurysm.
  
  
  METHODS
  The study was performed as a retrospective review of 283 patients with poor-grade SAH who underwent surgical obliteration of the aneurysm at multiple centers in Chugoku and Shikoku, Japan.
  
  
  RESULTS
  A favorable outcome at discharge was achieved in 97 of the 283 patients (34.3%). Age (p < 0.001), World Federation of Neurosurgical Societies (WFNS) grade V at admission (p = 0.002), improvement in WFNS grade after admission (p = 0.002), Fisher grade (p = 0.039) and a low-density area (LDA) associated with vasospasm on computed tomography (CT; p < 0.001) showed a significant association with outcome. Further analysis of WFNS grades indicated that most patients who only improved to preoperative grade IV from grade V at admission did not have a favorable outcome. Multivariate analysis identified age (especially of > or =65 years; p < 0.001), WFNS grade V (p < 0.001) and LDA associated with vasospasm on CT (p < 0.001) as predictors of a poor outcome, and improvement in WFNS grade (p = 0.001) as a predictor of a favorable outcome after surgical obliteration of the aneurysm.
  
  
  CONCLUSIONS
  Advanced age, WFNS grade V, improvement in WFNS grade, and LDA associated with vasospasm on CT were found to be independent predictors of clinical outcome, whereas rebleeding, early aneurysm surgery and treatment modality (surgical clipping or Guglielmi detachable coil embolization) were not independently associated with outcome in patients with poor-grade aneurysm.
authors.affiliation: Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Japan. shirao@yamaguchi-u.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shirao
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoneda
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kunitsugu
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ishihara
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Koizumi
authors.forename: Eiichi
authors.initials: E
authors.lastname: Suehiro
authors.forename: Sadahiro
authors.initials: S
authors.lastname: Nomura
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kato
authors.forename: Hirosuke
authors.initials: H
authors.lastname: Fujisawa
authors.forename: Michiyasu
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000401:mortality; D010351:Patient Discharge; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D020301:Vasospasm, Intracranial / Q000150:complications; D055815:Young Adult