Validation of the accuracy of the modified World Federation of Neurosurgical Societies subarachnoid hemorrhage grading scale for predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage.

Autor: Nguyen TA; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam.; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam., Mai TD; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.; Stroke Center, Bach Mai Hospital, Hanoi, Vietnam.; Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam., Vu LD; Radiology Centre, Bach Mai Hospital, Hanoi, Vietnam.; Department of Radiology, Hanoi Medical University, Hanoi, Vietnam., Dao CX; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.; Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Vietnam., Ngo HM; Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.; Department of Neurosurgery II, Neurosurgery Center, Vietnam-Germany Friendship Hospital, Hanoi, Vietnam.; Department of Surgery, Hanoi Medical University, Hanoi, Vietnam., Hoang HB; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.; Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam., Tran TA; Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.; Radiology Centre, Bach Mai Hospital, Hanoi, Vietnam.; Department of Radiology, Hanoi Medical University, Hanoi, Vietnam., Pham TQ; Department of Surgery, Hanoi Medical University, Hanoi, Vietnam.; Department of Neurosurgery, Bach Mai Hospital, Hanoi, Vietnam., Pham DT; Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam., Nguyen MH; Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam., Nguyen LQ; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam.; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam., Dao PV; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.; Stroke Center, Bach Mai Hospital, Hanoi, Vietnam.; Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam., Nguyen DN; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam., Vuong HTT; Emergency Department, Vietnam-Czechoslovakia Friendship Hospital, Hai Phong, Vietnam., Vu HD; Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam., Nguyen DD; Department of Neurosurgery II, Neurosurgery Center, Vietnam-Germany Friendship Hospital, Hanoi, Vietnam., Vu TD; Emergency Department, Agriculture General Hospital, Hanoi, Vietnam., Nguyen DT; Stroke Center, Bach Mai Hospital, Hanoi, Vietnam., Do ALN; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam.; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam., Nguyen CD; Department of Emergency and Critical Care Medicine, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam., Do SN; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.; Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.; Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Vietnam., Nguyen HT; Department of Surgery, Hanoi Medical University, Hanoi, Vietnam.; Department of Neurosurgery, Bach Mai Hospital, Hanoi, Vietnam., Nguyen CV; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam.; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam., Nguyen AD; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam.; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam., Luong CQ; Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam.; Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.; Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Aug 22; Vol. 18 (8), pp. e0289267. Date of Electronic Publication: 2023 Aug 22 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0289267
Abstrakt: Background: Evaluating the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) who may be at risk of poor outcomes using grading systems is one way to make a better decision on treatment for these patients. This study aimed to compare the accuracy of the modified World Federation of Neurosurgical Societies (WFNS), WFNS, and Hunt and Hess (H&H) Grading Scales in predicting the outcomes of patients with aSAH.
Methods: From August 2019 to June 2021, we conducted a multicenter prospective cohort study on adult patients with aSAH in three central hospitals in Hanoi, Vietnam. The primary outcome was the 90-day poor outcome, measured by a score of 4 (moderately severe disability) to 6 (death) on the modified Rankin Scale (mRS). We calculated the areas under the receiver operator characteristic (ROC) curve (AUROCs) to determine how well the grading scales could predict patient prognosis upon admission. We also used ROC curve analysis to find the best cut-off value for each scale. We compared AUROCs using Z-statistics and compared 90-day mean mRS scores among intergrades using the pairwise multiple-comparison test. Finally, we used logistic regression to identify factors associated with the 90-day poor outcome.
Results: Of 415 patients, 32% had a 90-day poor outcome. The modified WFNS (AUROC: 0.839 [95% confidence interval, CI: 0.795-0.883]; cut-off value≥2.50; PAUROC<0.001), WFNS (AUROC: 0.837 [95% CI: 0.793-0.881]; cut-off value≥3.5; PAUROC<0.001), and H&H scales (AUROC: 0.836 [95% CI: 0.791-0.881]; cut-off value≥3.5; PAUROC<0.001) were all good at predicting patient prognosis on day 90th after ictus. However, there were no significant differences between the AUROCs of these scales. Only grades IV and V of the modified WFNS (3.75 [standard deviation, SD: 2.46] vs 5.24 [SD: 1.68], p = 0.026, respectively), WFNS (3.75 [SD: 2.46] vs 5.24 [SD: 1.68], p = 0.026, respectively), and H&H scales (2.96 [SD: 2.60] vs 4.97 [SD: 1.87], p<0.001, respectively) showed a significant difference in the 90-day mean mRS scores. In multivariable models, with the same set of confounding variables, the modified WFNS grade of III to V (adjusted odds ratio, AOR: 9.090; 95% CI: 3.494-23.648; P<0.001) was more strongly associated with the increased risk of the 90-day poor outcome compared to the WFNS grade of IV to V (AOR: 6.383; 95% CI: 2.661-15.310; P<0.001) or the H&H grade of IV to V (AOR: 6.146; 95% CI: 2.584-14.620; P<0.001).
Conclusions: In this study, the modified WFNS, WFNS, and H&H scales all had good discriminatory abilities for the prognosis of patients with aSAH. Because of the better effect size in predicting poor outcomes, the modified WFNS scale seems preferable to the WFNS and H&H scales.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Nguyen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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