Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study
| Autor: | David Hasan, Blessing N.R. Jaja, Walter M. van den Bergh, Peter D. Le Roux, Karl Lothard Schaller, Julian Spears, Mervyn D.I. Vergouwen, Gordon D Murray, James C. Torner, Martin N. Stienen, Sen Yamagata, George K.C. Wong, R. Loch Macdonald, Nima Etminan, Peter J. Kirkpatrick, Michael D. Cusimano, Daniel Hänggi, Hester F. Lingsma, Erin M. Macdonald, John D. Pickard, Airton Leonardo de Oliveira Manoel, Hitoshi Fukuda, Kevin E. Thorpe, Bawarjan Schatlo, Michael M. Todd, Gustavo Saposnik, Ewout W. Steyerberg, Gabriel J.E. Rinkel, Tom A. Schweizer, Stephan A. Mayer, Muhammed Mamdani, Jose I. Suarez, Andrew J. Molyneux, S. Claiborne Johnston |
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| Přispěvatelé: | Experimental Vascular Medicine, ANS - Neurovascular Disorders, Public Health, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE) |
| Rok vydání: | 2018 |
| Předmět: |
ACCURACY
VASOSPASM INTRACRANIAL ANEURYSMS Glasgow Outcome Scale Aneurysm Ruptured Logistic regression Cohort Studies DOUBLE-BLIND 0302 clinical medicine ACUTE PHYSIOLOGY SCORE Risk of mortality Prospective Studies Registries 030212 general & internal medicine Non-U.S. Gov't 10. No inequality Prospective cohort study Randomized Controlled Trials as Topic RISK Medicine(all) Subarachnoid Hemorrhage/etiology Research Support Non-U.S. Gov't General Medicine Prognosis 3. Good health Observational Studies as Topic Aneurysm Ruptured/complications INFARCTION Cohort study medicine.medical_specialty CONTROLLED-TRIAL Research Support Risk Assessment 03 medical and health sciences MAGNESIUM-SULFATE Journal Article medicine Humans cardiovascular diseases Validation Studies Risk Assessment/methods Ruptured/complications business.industry Reproducibility of Results Intracranial Aneurysm Subarachnoid Hemorrhage Aneurysm Confidence interval nervous system diseases ddc:616.8 Patient Outcome Assessment Clinical trial Intracranial Aneurysm/complications Emergency medicine PROGNOSTICATION Observational study business 030217 neurology & neurosurgery |
| Zdroj: | British Medical Journal BMJ (Clinical research ed.), 360:j5745. British Medical Association British Medical Journal, 360 BMJ-British medical journal, 360:j5745. BMJ Publishing Group BMJ-Clinical research, 360. BMJ Publishing Group BMJ, Vol. 360, No 8137 (2018) P. j5745 Jaja, B N R, Saposnik, G, Lingsma, H F, Macdonald, E, Thorpe, K E, Mamdani, M, Steyerberg, E W, Molyneux, A J, Manoel, A L D O, Schatlo, B, Hanggi, D, Hasan, D M, Wong, G K C, Etminan, N, Fukuda, H, Torner, J, Schaller, K L, Suarez, J I, Stienen, M N, Vergouwen, M D I, Rinkel, G J E, Spears, J, Cusimano, M D, Todd, M, Le Roux, P, Kirkpatrick, P J, Pickard, J D, van den Bergh, W M, Murray, G, Johnston, S C, Yamagata, S, Mayer, S A & Schweizer, T A & Macdonald, R L 2018, ' Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage : the SAHIT multinational cohort study ', BMJ (Clinical research ed.), vol. 360, pp. j5745 . https://doi.org/10.1136/bmj.j5745 BMJ-British Medical Journal, 360:5745. BMJ PUBLISHING GROUP |
| ISSN: | 1756-1833 0959-8138 0959-8146 |
| DOI: | 10.1136/bmj.j5745 |
| Popis: | Objective - To develop and validate a set of practical prediction tools that reliably estimate the outcome of subarachnoid haemorrhage from ruptured intracranial aneurysms (SAH).Design - Cohort study with logistic regression analysis to combine predictors and treatment modality.Setting - Subarachnoid Haemorrhage International Trialists' (SAHIT) data repository, including randomised clinical trials, prospective observational studies, and hospital registries.Participants - Researchers collaborated to pool datasets of prospective observational studies, hospital registries, and randomised clinical trials of SAH from multiple geographical regions to develop and validate clinical prediction models.Main outcome measure - Predicted risk of mortality or functional outcome at three months according to score on the Glasgow outcome scale.Results - Clinical prediction models were developed with individual patient data from 10 936 patients and validated with data from 3355 patients after development of the model. In the validation cohort, a core model including patient age, premorbid hypertension, and neurological grade on admission to predict risk of functional outcome had good discrimination, with an area under the receiver operator characteristics curve (AUC) of 0.80 (95% confidence interval 0.78 to 0.82). When the core model was extended to a "neuroimaging model," with inclusion of clot volume, aneurysm size, and location, the AUC improved to 0.81 (0.79 to 0.84). A full model that extended the neuroimaging model by including treatment modality had AUC of 0.81 (0.79 to 0.83). Discrimination was lower for a similar set of models to predict risk of mortality (AUC for full model 0.76, 0.69 to 0.82). All models showed satisfactory calibration in the validation cohort.Conclusion - The prediction models reliably estimate the outcome of patients who were managed in various settings for ruptured intracranial aneurysms that caused subarachnoid haemorrhage. The predictor items are readily derived at hospital admission. The web based SAHIT prognostic calculator (http://sahitscore.com) and the related app could be adjunctive tools to support management of patients. |
| Databáze: | OpenAIRE |
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