Hunt-Hess Score at 48 Hours Improves Prognostication in Grade 5 Aneurysmal Subarachnoid Hemorrhage

Abstract

Patients with Hunt-Hess (HH)5 aneurysmal subarachnoid hemorrhage (SAH) have high mortality rates. Despite an initial moribund exam, a subset of patients progress to favorable outcomes. To evaluate the utility of delayed HH grading to improve prognostication. We retrospectively reviewed patients undergoing treatment of ruptured aneurysms at two level 1 stroke centers from January 2012 through December 2020. We collected relevant clinical information and developed a multivariate cox regression model to identify independent predictors of mortality. To evaluate the utility of delayed examinations in predicting outcomes, we re-assessed the HH grade at 48hours post admission and constructed a logistic regression model with potential confounders to predict mortality. From 2012 to 2020, 621 patients underwent treatment for aneurysmal SAH. We identified 63 HH5 patients (10%) with a mean age of 58years. Among these patients, the median length of stay was 14days, with 3 patients passing away within 48hours. The overall mortality rate was 63% at 24months. To predict mortality, our cox regression model found only age to be significant (P= 0.002). Delayed HH grading improved prognostication at 48hours and remained significant on multivariate analysis as a predictor of mortality (P= 0.0001). We observed a significant difference in mortality between patients HH5 and patients HH4 or lower at 48hours (P= 0.0003). Delayed reassessment of HH grade 48hours postadmission is a predictor of mortality, suggesting reassessment at 48hours in high grade SAH leads to better prognostication.