The Hijdra scale has significant prognostic value for the functional outcome of Fisher grade3 patients with subarachnoid hemorrhage.

Abstract

Despite its high prevalence among patients with aneurysmal subarachnoid hemorrhage (aSAH) and high risk of delayed cerebral ischemia (DCI), the Fisher grade3 category remains apoorly studied subgroup. The aim of this cohort study has been to investigate the prognostic value of the Hijdra sum scoring system for the functional outcome in patients with Fisher grade3 aSAH, in order to improve the risk stratification within this Fisher category. Initial CT scans of 72prospectively enrolled patients with Fisher grade3 aSAH were analyzed, and cisternal, ventricular, and total amount of blood were graded according to the Hijdra scale. Additionally, space-occupying subarachnoid blood clots were assessed. Outcome was evaluated after 6months. Within the subgroup of Fisher grade3, aSAH patients with an unfavorable outcome showed asignificantly larger cisternal Hijdra sum score (HSS: 21.1± 5.2) than patients with afavorable outcome (HSS: 17.6± 5.9; p= 0.009). However, both the amount of ventricular blood (p= 0.165) and space-occupying blood clots (p= 0.206) appeared to have no prognostic relevance. After adjusting for the patient's age, gender, tobacco use, clinical status at admission, and presence of intracerebral hemorrhage, the cisternal and total HSS remained the only independent parameters included in multivariate logistic regression models to predict functional outcome (p <0.01). The cisternal Hijdra score is fairly easy to perform and the present study indicates that it has an additional predictive value for the functional outcome within the Fisher3 category. We suggest that the Hijdra scale is apractically useful prognostic instrument for the risk evaluation after aSAH and should be applied more often in the clinical setting.