Radiological scales predicting delayed cerebral ischemia in subarachnoid hemorrhage: systematic review and meta-analysis

Wessel E Van Der Steen,Yvo B W E M Roos,Charles B L M Majoie,Henk A Marquering,René Van Den Berg,Eva L Leemans,Dagmar Verbaan

doi:10.1007/s00234-019-02161-9

Wessel E Van Der Steen, Yvo B W E M Roos + Show 5 more

Open Access

https://doi.org/10.1007/s00234-019-02161-9

Copy DOI

Abstract

PurposeDelayed cerebral ischemia (DCI) is a severe complication of aneurysmal subarachnoid hemorrhage (aSAH). The extent of subarachnoid blood is a strong predictor of DCI and is frequently estimated with the Fisher scale, modified Fisher scale, or Hijdra sum score. It is unclear which scale has the strongest association with clinical DCI. To evaluate this, we performed a systematic review of the literature.MethodsWe performed a MEDLINE and EMBASE search from 1980 to 20th of June 2017. Radiological grade and occurrence of clinical DCI were extracted along with odds ratios (ORs) for DCI. When possible, pooled ORs with 95% confidence intervals were calculated per grade increase on the radiological scale.ResultsFifty-three studies were included. The Fisher scale was significantly associated with DCI in 62% of the studies compared to 88–100% for the other scales. In studies using the Fisher scale, Fisher 3 had the strongest association with DCI (pooled OR 3.21 (1.87–5.49)). In studies using the modified Fisher score, DCI occurred most frequently (42%) in modified Fisher 4. No pooled OR could be calculated for the other scales.ConclusionThe Fisher scale, modified Fisher scale, and Hijdra sum score are all associated with clinical DCI. The risk of DCI, however, does not increase with increasing Fisher grade as opposed to the modified Fisher scale. Furthermore, the modified Fisher scale was more commonly significantly associated with DCI than the Fisher scale, which may advocate using the modified Fisher in future SAH-related studies.

Highlights

Delayed cerebral ischemia (DCI) is one of the most severe complications of aneurysmal subarachnoid hemorrhage and occurs in approximately 30% of the patients [1, 2]
We aimed to perform a systematic review to assess the associations of the Fisher scale, the modified Fisher scale, and Hijdra sum score with clinical DCI
The main reasons for exclusion were the following: amount of blood not assessed with the Fisher, modified Fisher, or Hijdra sum score (n = 38), clinical DCI not one of the assessed outcomes (n = 114), and no association between amount of blood and DCI could be determined (n = 51) (Fig. 1)

Summary

Introduction

Delayed cerebral ischemia (DCI) is one of the most severe complications of aneurysmal subarachnoid hemorrhage (aSAH) and occurs in approximately 30% of the patients [1, 2]. The extent of subarachnoid blood on admission computed tomography (CT) scan is one of the strongest predictors of DCI [3–5]. It is not clear which radiological grading scale has the strongest association with DCI. The first scale was introduced by Fisher et al in 1980 [7] This four-grade scale scores the amount of blood in the cisterns as absent (grade 1), diffuse thin (< 1 mm) (grade 2), thick (> 1 mm) (grade 3), or thin amount of blood in the cisterns with presence of intraventricular (IVH) or intraparenchymal (IPH) hemorrhage (grade 4). An adjusted version of the Fisher scale was published: the modified Fisher scale [8, 9]. This scale introduced a separate grade for patients with both a thick

Objectives

Methods

Results

Conclusion