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Comparative Analysis of Traditional Clinical Scores and Combined Grading Systems in Predicting 28-Day Mortality in Non-Traumatic Subarachnoid Hemorrhage
In Brief
An observational study evaluating Glasgow coma scale, Hunt-Hess scale, and 4 other interventions for Subarachnoid Hemorrhage, Aneurysmal. Completed, enrolled 451 participants across 1 site.
Detailed Summary
The investigators investigated the predictive ability of clinical and radiological scores, including the Glasgow coma scale (GCS), Hunt-Hess, World Federation of Neurological Surgeons (WFNS), and modified Fisher scales, as well as combined clinical scores such as the VASOGRADE and Ogilvy-Carter rating scales, for 28-day mortality in patients presenting to the emergency department (ED) with non-traumatic subarachnoid hemorrhage (SAH). Specifically, we tested the hypothesis that combined clinical scores are more reliable and superior to non-combined clinical and radiological scores in predicting 28-day mortality in non-traumatic SAH.
Study Details
Timeline
Interventions
The levels of response in the components of the Glasgow Coma Scale are 'scored' from 1, for no response, up to normal values of 4 (Eye-opening response) 5 ( Verbal response) and 6 (Motor response) The total Coma Score thus has values between three and 15, three being the worst and 15 being the highest.
The Hunt-Hess scale was used to assess SAH severity according to the clinical presentation and the visible neurological deficits. The Grades run from 1 to 5: * Grade 1: Asymptomatic or minimal headache, slight neck stiffness. * Grade 2: Moderate to severe headache, and neck stiffness, but no neurological deficit except cranial nerve palsy. * Grade 3: Drowsiness, confusion, or a mild focal deficit. * Grade 4: Stupor, moderate to severe hemiparesis, early decerebrate rigidity, and vegetative disturbance. * Grade 5: Deep coma, decerebrate rigidity, and a moribund appearance.
The World Federation of Neurological Surgeons (WFNS) scale, introduced in 1988, is used to evaluate the clinical severity of patients with SAH. This scale is derived from the GCS score and considers the presence of motor deficits: * Grade 1: GCS score of 15, no motor deficit * Grade 2: GCS score of 13 to 14, no motor deficit * Grade 3: GCS score of 13 to 14, with motor deficit * Grade 4: GCS score of 7 to 12, with or without motor deficit * Grade 5: GCS score of 3 to 6, with or without motor deficit
The modified Fisher scale was used to evaluate SAH severity by reference to the extent of hemorrhage as revealed by CT of the brain. Four grades are depending on the degree of bleeding observed: * Grade 0: No hemorrhage apparent in CT. * Grade 1: Minimal hemorrhage without intraventricular hemorrhage (IVH). * Grade 2: Thin or diffusely thin (\<1mm) hemorrhage with bilateral IVH. * Grade 3: Thick (\> 1 mm) hemorrhage without bilateral IVH. * Grade 4: Thick (\> 1 mm) hemorrhage with bilateral IVH.
The VASOGRADE scale was established to estimate the risk of delayed cerebral ischemia following SAH. This scale is based on the WFNS and the modified Fisher scales at admission. There are three categories: * Green: WFNS score of 1 or 2 and modified Fisher scale of 1 or 2. * Yellow: WFNS score of 1 or 3 and modified Fisher scale of 3 or 4. * Red: WFNS score of 4 or 5 and any modified Fisher scale score.
The Ogilvy and Carter scale is a grading system used to predict the outcomes of surgical treatment in patients with SAH due to a ruptured aneurysm. The scale considers multiple factors, including age, Hunt and Hess grade, Fisher grade, and aneurysm size, with a score assigned to each of these variables: * Age greater than 50 * Hunt and Hess grade of 4 to 5 * Fisher grade scores of 3 to 4 * Aneurysm size \>10 mm * An additional point is added for a giant posterior circulation aneurysm (≥25 mm)