Reconsidering the logic of World Federation of Neurosurgical Societies grading in patients with severe subarachnoid hemorrhage.

Fung, Christian; Inglin, Fabienne; Murek, Michael Konrad; Balmer, Mathias; Abu-Isa, Janine; Z'Graggen, Werner Josef; Ozdoba, Christoph; Gralla, Jan; Jakob, Stephan; Takala, Jukka; Beck, Jürgen; Raabe, Andreas (2015). Reconsidering the logic of World Federation of Neurosurgical Societies grading in patients with severe subarachnoid hemorrhage. Journal of neurosurgery, 124(2), pp. 299-304. American Association of Neurological Surgeons 10.3171/2015.2.JNS14614

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OBJECT Current data show a favorable outcome in up to 50% of patients with World Federation of Neurosurgical Societies (WFNS) Grade V subarachnoid hemorrhage (SAH) and a rather poor prediction of worst cases. Thus, the usefulness of the current WFNS grading system for identifying the worst scenarios for clinical studies and for making treatment decisions is limited. One reason for this lack of differentiation is the use of "negative" or "silent" diagnostic signs as part of the WFNS Grade V definition. The authors therefore reevaluated the WFNS scale by using "positive" clinical signs and the logic of the Glasgow Coma Scale as a progressive herniation score. METHODS The authors performed a retrospective analysis of 182 patients with SAH who had poor grades on the WFNS scale. Patients were graded according to the original WFNS scale and additionally according to a modified classification, the WFNS herniation (hWFNS) scale (Grade IV, no clinical signs of herniation; Grade V, clinical signs of herniation). The prediction of poor outcome was compared between these two grading systems. RESULTS The positive predictive values of Grade V for poor outcome were 74.3% (OR 3.79, 95% CI 1.94-7.54) for WFNS Grade V and 85.7% (OR 8.27, 95% CI 3.78-19.47) for hWFNS Grade V. With respect to mortality, the positive predictive values were 68.3% (OR 3.9, 95% CI 2.01-7.69) for WFNS Grade V and 77.9% (OR 6.22, 95% CI 3.07-13.14) for hWFNS Grade V. CONCLUSIONS Limiting WFNS Grade V to the positive clinical signs of the Glasgow Coma Scale such as flexion, extension, and pupillary abnormalities instead of including "no motor response" increases the prediction of mortality and poor outcome in patients with severe SAH.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Forschungsbereich Pavillon 52 > Forschungsgruppe Intensivmedizin

UniBE Contributor:

Fung, Christian; Murek, Michael Konrad; Abu-Isa, Janine; Z'Graggen, Werner Josef; Ozdoba, Christoph; Gralla, Jan; Jakob, Stephan; Takala, Jukka; Beck, Jürgen and Raabe, Andreas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-3085

Publisher:

American Association of Neurological Surgeons

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

05 Oct 2015 09:28

Last Modified:

26 Jun 2016 02:07

Publisher DOI:

10.3171/2015.2.JNS14614

PubMed ID:

26381248

Uncontrolled Keywords:

GCS, mGCS = Glasgow Coma Scale, motor score of the GCS Glasgow Coma Scale PPV = positive predictive value SAH = subarachnoid hemorrhage WFNS, hWFNS = World Federation of Neurosurgical Societies, WFNS herniation scale World Federation of Neurosurgical Societies grading mRS = modified Rankin Scale subarachnoid hemorrhage vascular disorders

BORIS DOI:

10.7892/boris.72167

URI:

https://boris.unibe.ch/id/eprint/72167

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