Herniation World Federation of Neurosurgical Societies Scale Improves Prediction of Outcome in Patients With Poor-Grade Aneurysmal Subarachnoid Hemorrhage.

Raabe, Andreas; Beck, Jürgen; Goldberg, Johannes; Z'Graggen, Werner J; Branca, Mattia; Marbacher, Serge; D'Alonzo, Donato; Fandino, Javier; Stienen, Martin N; Neidert, Marian C; Burkhardt, Jan-Karl; Regli, Luca; Hlavica, Martin; Seule, Martin; Roethlisberger, Michel; Guzman, Raphael; Zumofen, Daniel Walter; Maduri, Rodolfo; Daniel, Roy Thomas; El Rahal, Amir; ... (2022). Herniation World Federation of Neurosurgical Societies Scale Improves Prediction of Outcome in Patients With Poor-Grade Aneurysmal Subarachnoid Hemorrhage. Stroke, 53(7), pp. 2346-2351. Lippincott Williams & Wilkins 10.1161/STROKEAHA.121.036699

[img] Text
Raabe_Stroke_2022.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (329kB)
[img]
Preview
Text
Raabe_Stroke_2022_AAM.pdf - Accepted Version
Available under License Publisher holds Copyright.

Download (386kB) | Preview

BACKGROUND

Favorable outcomes are seen in up to 50% of patients with World Federation of Neurosurgical Societies (WFNS) grade V aneurysmal subarachnoid hemorrhage. Therefore, the usefulness of the current WFNS grading system for identifying the worst scenarios for clinical studies and for making treatment decisions is limited. We previously modified the WFNS scale by requiring positive signs of brain stem dysfunction to assign grade V. This study aimed to validate the new herniation WFNS grading system in an independent prospective cohort.

METHODS

We conducted an international prospective multicentre study in poor-grade aneurysmal subarachnoid hemorrhage patients comparing the WFNS classification with a modified version-the herniation WFNS scale (hWFNS). Here, only patients who showed positive signs of brain stem dysfunction (posturing, anisocoric, or bilateral dilated pupils) were assigned hWFNS grade V. Outcome was assessed by modified Rankin Scale score 6 months after hemorrhage. The primary end point was the difference in specificity of the WFNS and hWFNS grading with respect to poor outcomes (modified Rankin Scale score 4-6).

RESULTS

Of the 250 patients included, 237 reached the primary end point. Comparing the WFNS and hWFNS scale after neurological resuscitation, the specificity to predict poor outcome increased from 0.19 (WFNS) to 0.93 (hWFNS) (McNemar, P<0.001) whereas the sensitivity decreased from 0.88 to 0.37 (P<0.001), and the positive predictive value from 61.9 to 88.3 (weighted generalized score statistic, P<0.001). For mortality, the specificity increased from 0.19 to 0.93 (McNemar, P<0.001), and the positive predictive value from 52.5 to 86.7 (weighted generalized score statistic, P<0.001).

CONCLUSIONS

The identification of objective positive signs of brain stem dysfunction significantly improves the specificity and positive predictive value with respect to poor outcome in grade V patients. Therefore, a simple modification-presence of brain stem signs is required for grade V-should be added to the WFNS classification.

REGISTRATION

URL: https://clinicaltrials.gov; Unique identifier: NCT02304328.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Raabe, Andreas, Goldberg, Johannes, Z'Graggen, Werner Josef, Branca, Mattia

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0039-2499

Publisher:

Lippincott Williams & Wilkins

Funders:

[116] Swiss Heart Foundation = Schweizerische Herzstiftung

Language:

English

Submitter:

Pubmed Import

Date Deposited:

24 Mar 2022 11:09

Last Modified:

20 Feb 2024 14:16

Publisher DOI:

10.1161/STROKEAHA.121.036699

PubMed ID:

35317612

BORIS DOI:

10.48350/167945

URI:

https://boris.unibe.ch/id/eprint/167945

Actions (login required)

Edit item Edit item
Provide Feedback