Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is frequently complicated by permanent shunt-dependent hydrocephalus, but it is difficult to predict which patients are at highest risk. This study seeks to identify novel variables associated with shunt dependency after aSAH and to create a predictive algorithm that improves upon existing models. Retrospective case control design was used. Patients who presented with aSAH and external ventricular drain (EVD) placement were included. Those who successfully weaned off their EVD were compared with those who required shunt placement. Demographic and treatment data were analyzed using univariate and multivariable logistic regression. Receiver operating characteristic (ROC) was used to compare the proposed model's performance against existing ones (BNI, CHESS, and SDASH). 100 patients were included: 50 No Shunt and 50 Shunt. Advanced age, elevated modified Graeb score, intraventricular hemorrhage, increased clot thickness, acute hydrocephalus, and CSF protein >110mg/dL prior to wean attempt were all found to be significantly associated with progression to shunt-dependency (p = .0351, .0022, .0407, .0274, .0014, and .0064, respectively). Multivariate regression demonstrated an area under the curve of 0.7852 (p < .0001), outperforming those of the other models. Our study suggests that elevated modified Graeb score on initial CT and high CSF protein levels prior to EVD wean are important prognostic indicators for development of shunt dependency after aSAH. Integrating these findings into clinical practice may aid in earlier and more targeted decision-making.
Published Version
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