title: The VASOGRADE: A Simple Grading Scale for Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage.
abstract: OBJECTIVE
  Patients are classically at risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. We validated a grading scale-the VASOGRADE-for prediction of DCI.
  
  
  METHODS
  We used data of 3 phase II randomized clinical trials and a single hospital series to assess the relationship between the VASOGRADE and DCI. The VASOGRADE derived from previously published risk charts and consists of 3 categories: VASOGRADE-Green (modified Fisher scale 1 or 2 and World Federation of Neurosurgical Societies scale [WFNS] 1 or 2); VASOGRADE-Yellow (modified Fisher 3 or 4 and WFNS 1-3); and VASOGRADE-Red (WFNS 4 or 5, irrespective of modified Fisher grade). The relation between the VASOGRADE and DCI was assessed by logistic regression models. The predictive accuracy of the VASOGRADE was assessed by receiver operating characteristics curve and calibration plots.
  
  
  RESULTS
  In a cohort of 746 patients, the VASOGRADE significantly predicted DCI (P<0.001). The VASOGRADE-Yellow had a tendency for increased risk for DCI (odds ratio [OR], 1.31; 95% CI, 0.77-2.23) when compared with VASOGRADE-Green; those with VASOGRADE-Red had a 3-fold higher risk of DCI (OR, 3.19; 95% CI, 2.07-4.50). Studies were not a significant confounding factor between the VASOGRADE and DCI. The VASOGRADE had an adequate discrimination for prediction of DCI (area under the receiver operating characteristics curve=0.63) and good calibration.
  
  
  CONCLUSIONS
  The VASOGRADE results validated previously published risk charts in a large and diverse sample of subarachnoid hemorrhage patients, which allows DCI risk stratification on presentation after subarachnoid hemorrhage. It could help to select patients at high risk of DCI, as well as standardize treatment protocols and research studies.
authors.affiliation: From the Division of Neurosurgery, St Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada (B.N.J., T.R.M., D.T.P., T.A.S., R.L.M.); Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital (A.L.d.O.M, H.Y., W.Q., E.K.); and Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, Netherlands (M.R.G.). airtonleo.manoel@gmail.com manoela@smh.ca.
authors.forename: Airton Leonardo
authors.initials: AL
authors.lastname: de Oliveira Manoel
authors.affiliation: From the Division of Neurosurgery, St Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada (B.N.J., T.R.M., D.T.P., T.A.S., R.L.M.); Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital (A.L.d.O.M, H.Y., W.Q., E.K.); and Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, Netherlands (M.R.G.).
authors.forename: Blessing N
authors.initials: BN
authors.lastname: Jaja
authors.affiliation: From the Division of Neurosurgery, St Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada (B.N.J., T.R.M., D.T.P., T.A.S., R.L.M.); Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital (A.L.d.O.M, H.Y., W.Q., E.K.); and Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, Netherlands (M.R.G.).
authors.forename: Menno R
authors.initials: MR
authors.lastname: Germans
authors.affiliation: From the Division of Neurosurgery, St Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada (B.N.J., T.R.M., D.T.P., T.A.S., R.L.M.); Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital (A.L.d.O.M, H.Y., W.Q., E.K.); and Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, Netherlands (M.R.G.).
authors.forename: Han
authors.initials: H
authors.lastname: Yan
authors.affiliation: From the Division of Neurosurgery, St Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada (B.N.J., T.R.M., D.T.P., T.A.S., R.L.M.); Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital (A.L.d.O.M, H.Y., W.Q., E.K.); and Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, Netherlands (M.R.G.).
authors.forename: Winnie
authors.initials: W
authors.lastname: Qian
authors.affiliation: From the Division of Neurosurgery, St Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada (B.N.J., T.R.M., D.T.P., T.A.S., R.L.M.); Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital (A.L.d.O.M, H.Y., W.Q., E.K.); and Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, Netherlands (M.R.G.).
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Kouzmina
authors.affiliation: From the Division of Neurosurgery, St Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada (B.N.J., T.R.M., D.T.P., T.A.S., R.L.M.); Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital (A.L.d.O.M, H.Y., W.Q., E.K.); and Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, Netherlands (M.R.G.).
authors.forename: Tom R
authors.initials: TR
authors.lastname: Marotta
authors.affiliation: From the Division of Neurosurgery, St Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada (B.N.J., T.R.M., D.T.P., T.A.S., R.L.M.); Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital (A.L.d.O.M, H.Y., W.Q., E.K.); and Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, Netherlands (M.R.G.).
authors.forename: David
authors.initials: D
authors.lastname: Turkel-Parrella
authors.affiliation: From the Division of Neurosurgery, St Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada (B.N.J., T.R.M., D.T.P., T.A.S., R.L.M.); Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital (A.L.d.O.M, H.Y., W.Q., E.K.); and Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, Netherlands (M.R.G.).
authors.forename: Tom A
authors.initials: TA
authors.lastname: Schweizer
authors.affiliation: From the Division of Neurosurgery, St Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada (B.N.J., T.R.M., D.T.P., T.A.S., R.L.M.); Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital (A.L.d.O.M, H.Y., W.Q., E.K.); and Department of Neurosurgery, St Elisabeth Ziekenhuis, Tilburg, Netherlands (M.R.G.).
authors.forename: R Loch
authors.initials: RL
authors.lastname: Macdonald
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis*; D013997:Time Factors
keywords: cerebral ischemia; subarachnoid hemorrhage