Abstract
Numerous grading scales have been proposed to predict the outcome of aneurysmal subarachnoid hemorrhage (SAH); however, these have not been validated in angiogram-negative SAH patients. In this study, we aim to validate and compare the aneurysmal SAH grading scales in angiogram-negative SAH patients. There were 190 angiogram-negative SAH patients analyzed from January 2014 to December 2015. The outcomes were measured by delayed cerebral ischemia (DCI) and poor outcome (defined as modified Rankin Scale (mRS) 3-6 or 4-6). The predictive performance of the grading scales was assessed via evaluation of distribution, trend, association, and discrimination. In regard to the distribution, none of the patients were categorized as HAIR 8 and SAH score 8. Both grading scales indicated a significant trend between scores and outcome (P < 0.05), and association with the outcome (OR > 1). The modified Fisher Scale (mFS), World Federation of Neurosurgical Societies scale (WFNS), and combined scores VASOGRADE and HAIR showed good predictive accuracy (area under the curve (AUC) > 0.750) for DCI. The predictive accuracy in each scale performed well in predicting poor outcome, with the exception of mFS and the Subarachnoid hemorrhage Early Brain Edema Score (SEBES). However, the mFS performed with increased accuracy when predicting mRS 4-6. The VASOGRADE, HAIR, and WFNS may be valuable prognostic tools for predicting both DCI and poor outcome. The mFS can be applicable for predicting DCI and mRS 4-6. The SAH score and the Hunt-Hess were also optimal for predicting poor outcome. The predictive performance of SEBES was relatively poor compared to the other scales.
Highlights
Angiogram-negative subarachnoid hemorrhage (SAH), accounting for 15-20% of SAH, was considered a special type of spontaneous SAH with a benign progression and better outcome compared to aneurysmal SAH [1, 2]
Patients were excluded if they sought care more than 3 days after the onset of SAH, if they had a history of trauma or previous brain injury, if the patient had serious comorbidities prior to SAH onset, and lastly, if patients’ radiological data were unavailable
A total of 208 SAH patients had negative angiogram at admission, with 190 patients included in the final cohort for analysis
Summary
Angiogram-negative subarachnoid hemorrhage (SAH), accounting for 15-20% of SAH, was considered a special type of spontaneous SAH with a benign progression and better outcome compared to aneurysmal SAH [1, 2]. More than 40 prognostic grading scores [3], including the Hunt-Hess (HH) [4], the World Federation of Neurosurgical Societies scale (WFNS) [5], the modified Fisher Scale (mFS) [6], the Subarachnoid hemorrhage Early Brain Edema Score (SEBES) [7], the VASOGRADE [8], the HAIR [9], and the SAH score [10], were proposed to guide the clinical treatment after SAH None of these were initially designed for use in angiogram-negative SAH patients. An optimal selection of grading scales may assist neurologists in making informed decisions, allowing for improved care and treatment in angiogram-negative patients
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