Factors associated with clinical and radiological status on admission in patients with aneurysmal subarachnoid hemorrhage

Daniel W Zumofen, Michel Roethlisberger, Rita Achermann, Schatlo Bawarjan, Martin N Stienen, Christian Fung, Donato D'Alonzo, Nicolai Maldaner, Andrea Ferrari, Marco V Corniola, Daniel Schoeni, Johannes Goldberg (+11 others)
2018
Grading scales yield objective measure of the severity of aneurysmal subarachnoid hemorrhage and serve as to guide treatment decisions and for prognostication. The purpose of this cohort study was to determine what factors govern a patient's disease-specific admission scores in a representative Central European cohort. The Swiss Study of Subarachnoid Hemorrhage includes anonymized data from all tertiary referral centers serving subarachnoid hemorrhage patients in Switzerland. The 2009-2014
more » ... The 2009-2014 dataset was used to evaluate the impact of patient and aneurysm characteristics on the patients' status at admission using descriptive and multivariate regression analysis. The primary/co-primary endpoints were the GCS and the WFNS grade. The secondary endpoints were the Fisher grade, the presence of a thick cisternal or ventricular clot, the presence of a new focal neurological deficit or cranial nerve palsy, and the patient's intubation status. In our cohort of 1787 consecutive patients, increasing patient age by 10 years and low pre-ictal functional status (mRS 3-5) were inversely correlated with "high" GCS score (GCS 13) (OR 0.91, 95% CI 0.84-0.97 and OR 0.67, 95% CI 0.31-1.46), "low" WFNS grade (grade VI-V) (OR 1.21, 95% CI 1.04-1.20 and OR 1.47, 95% CI 0.66-3.27), and high Fisher grade (grade III-IV) (OR 1.08, 95% CI 1.00-1.17 and OR 1.54, 95% CI 0.55-4.32). Other independent predictors for the patients' clinical and radiological condition at admission were the ruptured aneurysms' location and its size. In sum, chronological age and pre-ictal functional status, as well as the ruptured aneurysm's location and size, determine the patients' clinical and radiological condition at admission to the tertiary referral hospital. (2018). Factors associated with clinical and radiological status on admission in patients with aneurysmal subarachnoid hemorrhage. Neurosurgical Review, 41(4):1059-1069. Abstract 1 2 Background: Grading scales yield objective measure of the severity of aneurysmal subarachnoid hemorrhage and 3 serve as to guide to treatment decisions and for prognostication. The purpose of this cohort study was to 4 determine what factors govern a patient's disease-specific scores in a representative Central European cohort. 5 6 Methods: The Swiss Study of Subarachnoid Hemorrhage includes anonymized data from all tertiary referral 7 centers serving subarachnoid hemorrhage patients in Switzerland. The 2009-2014 dataset was used to evaluate 8 the impact of patient-and aneurysm-characteristics on the patients' status at admission using descriptive and 9 multivariate regression analysis. The primary/co-primary endpoints were the GCS and the WFNS grade. The 10 secondary endpoints were the Fisher grade, the presence of a thick intraventricular clot, the presence of a new 11 neurological deficit or cranial nerve palsy, and the patient's intubation status. 12 13 Results: In our cohort of 1787 consecutive patients, increasing patient age by 10 years and low pre-ictal 14 functional status (mRS 3-5) were inversely correlated with "high" GCS score (GCS ≥13) (OR 0.91, 95%CI 0.84-15 0.97 and OR 0.67, 95%CI 0.31-1.46), "low" WFNS grade (grade VI-V) (OR 1.21, 95%CI 1.04-1.20 and OR 16 1.47, 95%CI 0.66-3.27), and "high" Fisher grade (grade III-IV) (OR 1.08, 95%CI 1.00-1.17 and OR 1.54, 17 95%CI 0.55-4.32). Other independent predictors for the patients' clinical and radiological condition at admission 18 were the ruptured aneurysms' location and its size. 19 20 Conclusion: Patient age and pre-ictal functional status, as well as the ruptured aneurysm's location and size 21 determine the patients' clinical and radiological condition at admission to the tertiary referral hospital. 22 23 24
doi:10.5167/uzh-149901 fatcat:4b3gl5zpz5gongppwnozoyakii