Validation and Optimization of Barrow Neurological Institute Score in Prediction of Adverse Events and Functional Outcome After Subarachnoid Hemorrhage—Creation of the HATCH (Hemorrhage, Age, Treatment, Clinical State, Hydrocephalus) Score
| Autor: | Menno R. Germans, Isabel C Hostettler, Johannes Konstantin Richter, Carl Muroi, Marian Christoph Neidert, Luca Regli, Martina Sebök, Athina Pangalu, Gareth Ambler, Peter Prömmel |
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| Přispěvatelé: | University of Zurich, Germans, Menno Robbert |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Subarachnoid hemorrhage Clinical Neurology 610 Medicine & health Severity of Illness Index Brain Ischemia Cohort Studies 10180 Clinic for Neurosurgery 03 medical and health sciences 0302 clinical medicine Cerebral vasospasm 10043 Clinic for Neuroradiology Internal medicine medicine Humans Vasospasm Intracranial 030212 general & internal medicine Delayed cerebral ischemia Aged Outcome Framingham Risk Score Barrow neurological institute grade Cerebral infarction business.industry Glasgow Outcome Scale Area under the curve Recovery of Function Middle Aged Subarachnoid Hemorrhage Prognosis medicine.disease 2746 Surgery Hydrocephalus 2728 Neurology (clinical) Cohort Cardiology Female Surgery Neurology (clinical) Prediction business 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgery. 88:96-105 |
| ISSN: | 1524-4040 0148-396X |
| DOI: | 10.1093/neuros/nyaa316 |
| Popis: | BACKGROUND The Barrow Neurological Institute (BNI) score, measuring maximal thickness of aneurysmal subarachnoid hemorrhage (aSAH), has previously shown to predict symptomatic cerebral vasospasms (CVSs), delayed cerebral ischemia (DCI), and functional outcome. OBJECTIVE To validate the BNI score for prediction of above-mentioned variables and cerebral infarct and evaluate its improvement by integrating further variables which are available within the first 24 h after hemorrhage. METHODS We included patients from a single center. The BNI score for prediction of CVS, DCI, infarct, and functional outcome was validated in our cohort using measurements of calibration and discrimination (area under the curve [AUC]). We improved it by adding additional variables, creating a novel risk score (measure by the dichotomized Glasgow Outcome Scale) and validated it in a small independent cohort. RESULTS Of 646 patients, 41.5% developed symptomatic CVS, 22.9% DCI, 23.5% cerebral infarct, and 29% had an unfavorable outcome. The BNI score was associated with all outcome measurements. We improved functional outcome prediction accuracy by including age, BNI score, World Federation of Neurologic Surgeons, rebleeding, clipping, and hydrocephalus (AUC 0.84, 95% CI 0.8-0.87). Based on this model we created a risk score (HATCH-Hemorrhage, Age, Treatment, Clinical State, Hydrocephalus), ranging 0 to 13 points. We validated it in a small independent cohort. The validated score demonstrated very good discriminative ability (AUC 0.84 [95% CI 0.72-0.96]). CONCLUSION We developed the HATCH score, which is a moderate predictor of DCI, but excellent predictor of functional outcome at 1 yr after aSAH. |
| Databáze: | OpenAIRE |
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