The Hijdra scale has significant prognostic value for the functional outcome of Fisher grade 3 patients with subarachnoid hemorrhage.
OBJECTIVE
Despite its high prevalence among patients with aneurysmal subarachnoid hemorrhage (aSAH) and high risk of delayed cerebral ischemia (DCI), the Fisher grade 3 category remains a poorly studied subgroup. The aim of this cohort study has been to investigate the prognostic value of the Hijdra sum scoring system for the functional outcome in patients with Fisher grade 3 aSAH, in order to improve the risk stratification within this Fisher category.


METHODS
Initial CT scans of 72 prospectively enrolled patients with Fisher grade 3 aSAH were analyzed, and cisternal, ventricular, and total amount of blood were graded according to the Hijdra scale. Additionally, space-occupying subarachnoid blood clots were assessed. Outcome was evaluated after 6 months.


RESULTS
Within the subgroup of Fisher grade 3, aSAH patients with an unfavorable outcome showed a significantly larger cisternal Hijdra sum score (HSS: 21.1 ± 5.2) than patients with a favorable outcome (HSS: 17.6 ± 5.9; p = 0.009). However, both the amount of ventricular blood (p = 0.165) and space-occupying blood clots (p = 0.206) appeared to have no prognostic relevance. After adjusting for the patient's age, gender, tobacco use, clinical status at admission, and presence of intracerebral hemorrhage, the cisternal and total HSS remained the only independent parameters included in multivariate logistic regression models to predict functional outcome (p < 0.01).


CONCLUSIONS
The cisternal Hijdra score is fairly easy to perform and the present study indicates that it has an additional predictive value for the functional outcome within the Fisher 3 category. We suggest that the Hijdra scale is a practically useful prognostic instrument for the risk evaluation after aSAH and should be applied more often in the clinical setting.
Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. julia.bretz@charite.de.
Julia S
JS
Bretz
Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Falk
F
Von Dincklage
Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.|Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Johannes
J
Woitzik
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Maren K L
MKL
Winkler
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.|Departments of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Sebastian
S
Major
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.|Departments of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Jens P
JP
Dreier
Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Georg
G
Bohner
Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Michael
M
Scheel
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy
Delayed Cerebral Ischemia; Fisher Grade; Fisher Scale; Initial Compute Tomography; Unfavorable Outcome