Abstract
BackgroundAneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH.MethodsWe studied patients enrolled in the International Subarachnoid Aneurysm Trial (ISAT), a randomized multicentre trial to compare coiling and clipping in aSAH patients.Several models were explored to estimate a patient's outcome according to the modified Rankin Scale (mRS) at two months after aSAH. Our final model was validated internally with bootstrapping techniques.ResultsThe study population comprised of 2,128 patients of whom 159 patients died within 2 months (8%). Multivariable proportional odds analysis identified World Federation of Neurosurgical Societies (WFNS) grade as the most important predictor, followed by age, sex, lumen size of the aneurysm, Fisher grade, vasospasm on angiography, and treatment modality. The model discriminated moderately between those with poor and good mRS scores (c statistic = 0.65), with minor optimism according to bootstrap re-sampling (optimism corrected c statistic = 0.64).ConclusionWe presented a calibrated and internally validated ordinal prognostic model to predict two month mRS in aSAH patients who survived the early stage up till a treatment decision. Although generalizability of the model is limited due to the selected population in which it was developed, this model could eventually be used to support clinical decision making after external validation.Trial RegistrationInternational Standard Randomised Controlled Trial, Number ISRCTN49866681
Highlights
Aneurysmal subarachnoid haemorrhage is a devastating event with a frequently disabling outcome
A total of 2,143 patients were recruited to the International Subarachnoid Aneurysm Trial (ISAT) trial by 43 neurosurgical centres, mainly in Europe
Univariate analyses in the binary models for different cut offs, the proportional odds (PO) model, and the linear regression model are presented in table 2
Summary
Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. Prediction research typically aims to predict outcome of individual patients after the onset of a certain disease, using prognostic models. These models, preferably based on data directly available at hospital admission, are essential to support clinical decision making, and to facilitate reliable comparison of outcomes between different patient series and variation in results over time. From a clinical point of view dichotomisation may lead to less useful models. For a patient with a minor stroke a model predicting survival versus mortality is of limited value since the risk is low, while a prediction of complete recovery versus some remaining symptoms may be very useful. For a patient with a severe stroke, this will be the other way around
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