The Barrow Neurological Institute Grading Scale as a Predictor for Delayed Cerebral Ischemia and Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From a Nationwide Patient Registry (Swiss SOS).

Neidert, Marian Christoph; Maldaner, Nicolai; Stienen, Martin Nikolaus; Roethlisberger, Michel; Zumofen, Daniel W; D'Alonzo, Donato; Marbacher, Serge; Maduri, Rodolfo; Hostettler, Isabel Charlotte; Schatlo, Bawarjan; Schneider, Michel M; Seule, Martin A; Schöni, Daniel Stephan; Goldberg, Johannes; Fung, Christian; Arrighi, Marta; Valsecchi, Daniele; Bijlenga, Philippe; Schaller, Karl; Bozinov, Oliver; ... (2018). The Barrow Neurological Institute Grading Scale as a Predictor for Delayed Cerebral Ischemia and Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From a Nationwide Patient Registry (Swiss SOS). Neurosurgery, 83(6), pp. 1286-1293. Lippincott Williams & Wilkins 10.1093/neuros/nyx609

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BACKGROUND The Barrow Neurological Institute (BNI) scale is a novel quantitative scale measuring maximal subarachnoid hemorrhage (SAH) thickness to predict delayed cerebral ischemia (DCI). This scale could replace the Fisher score, which was traditionally used for DCI prediction. OBJECTIVE To validate the BNI scale. METHODS All patient data were obtained from the prospective aneurysmal SAH multicenter registry. In 1321 patients, demographic data, BNI scale, DCI, and modified Rankin Scale (mRS) score up to the 1-yr follow-up (1FU) were available for descriptive and univariate statistics. Outcome was dichotomized in favorable (mRS 0-2) and unfavorable (mRS 3-6). Odds ratios (OR) for DCI of Fisher 3 patients (n = 1115, 84%) compared to a control cohort of Fisher grade 1, 2, and 4 patients (n = 206, 16%) were calculated for each BNI grade separately. RESULTS Overall, 409 patients (31%) developed DCI with a high DCI rate in the Fisher 3 cohort (34%). With regard to the BNI scale, DCI rates went up progressively from 26% (BNI 2) to 38% (BNI 5) and corresponding OR for DCI increased from 1.9 (1.0-3.5, 95% confidence interval) to 3.4 (2.1-5.3), respectively. BNI grade 5 patients had high rates of unfavorable outcome with 75% at discharge and 58% at 1FU. Likelihood for unfavorable outcome was high in BNI grade 5 patients with OR 5.9 (3.9-8.9) at discharge and OR 6.6 (4.1-10.5) at 1FU. CONCLUSION This multicenter external validation analysis confirms that patients with a higher BNI grade show a significantly higher risk for DCI; high BNI grade was a predictor for unfavorable outcome at discharge and 1FU.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Schöni, Daniel Stephan; Goldberg, Johannes and Fung, Christian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0148-396X

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Nicole Söll

Date Deposited:

23 Apr 2018 12:10

Last Modified:

18 Nov 2018 01:30

Publisher DOI:

10.1093/neuros/nyx609

PubMed ID:

29351673

Uncontrolled Keywords:

Aneurysmal subarachnoid hemorrhage Barrow Neurological Institute grading scale Delayed cerebral ischemia Subarachnoid hemorrhage

BORIS DOI:

10.7892/boris.113858

URI:

https://boris.unibe.ch/id/eprint/113858

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