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Changes in outcome prediction during the first week after subarachnoid hemorrhage

Changes in outcome prediction during the first week after subarachnoid hemorrhage
Changes in outcome prediction during the first week after subarachnoid hemorrhage
BACKGROUND: Prediction of long-term outcome based on initial neurological condition after aneurysmal subarachnoid hemorrhage varies with time. To date, studies have been limited to early time points and have reported that prognostication is best after resuscitation.OBJECTIVE: To describe how prediction of outcome varies from ictus through the first week of admission.METHODS: A retrospective analysis of patients with a diagnosis of aneurysmal subarachnoid hemorrhage recruited to a prospective database. Neurological condition was recorded on each day of the inpatient stay, up to day 7, using World Federation of Neurological Societies score (WFNS). Poor outcome was defined by modified Rankin scale of 3-6 at 3 months. Outcome prediction was assessed using area under the curve (AUC) after binary logistic regression.RESULTS: Of 645 patients, 55(14%) patients with WFNS 1&2 and 77(45%) patients with WFNS 4&5 on day 0 had a poor outcome. 30(8%) patients with WFNS 1&2 and 54(81%) patients with WFNS 4&5 on day 7 had a poor outcome. Prognostication using WFNS improved from day 0 to day 7 (AUC = 70.1%, CI 65.0%–75.1% vs AUC = 81.9%, CI 77.4%–86.0%) with an incremental improvement with each day in between, and the largest increases early around the time of resuscitation.CONCLUSION: Prediction of outcome improves beyond the initial resuscitation, up to day 7 of admission, with no evidence of any deterioration around the time of treatment or delayed complications like delayed cerebral ischemia. This is important when prognosticating for clinical purposes and emphasizes the importance of standardization of timing of WFNS in research.
2633-0873
Booker, James
5d05bf89-80c0-4dc2-81ec-1bdb94d435cd
Barron, Peter
88ee074f-c3bb-430b-a73b-82b81ea1b75d
Newitt, Laura
698a6e22-a733-4523-8e91-7a9295a9054c
Chhugani, Simran
c97445a2-cd47-4364-9e8b-239626c05e85
Sarwar, Awais
0d73b873-ef8e-48e5-a0e5-9d45dcfb9a70
Ewbank, Frederick
70a00611-6654-4016-9be7-cd7bbc9d4a4d
Gaastra, Ben
c7b7f371-706b-4d59-9150-94e8f254e205
Bulters, Diederik
d6f9644a-a32f-45d8-b5ed-be54486ec21d
Booker, James
5d05bf89-80c0-4dc2-81ec-1bdb94d435cd
Barron, Peter
88ee074f-c3bb-430b-a73b-82b81ea1b75d
Newitt, Laura
698a6e22-a733-4523-8e91-7a9295a9054c
Chhugani, Simran
c97445a2-cd47-4364-9e8b-239626c05e85
Sarwar, Awais
0d73b873-ef8e-48e5-a0e5-9d45dcfb9a70
Ewbank, Frederick
70a00611-6654-4016-9be7-cd7bbc9d4a4d
Gaastra, Ben
c7b7f371-706b-4d59-9150-94e8f254e205
Bulters, Diederik
d6f9644a-a32f-45d8-b5ed-be54486ec21d

Booker, James, Barron, Peter, Newitt, Laura, Chhugani, Simran, Sarwar, Awais, Ewbank, Frederick, Gaastra, Ben and Bulters, Diederik (2022) Changes in outcome prediction during the first week after subarachnoid hemorrhage. Neurosurgery Open, 3 (4), [e00021]. (doi:10.1227/neuopn.0000000000000021).

Record type: Article

Abstract

BACKGROUND: Prediction of long-term outcome based on initial neurological condition after aneurysmal subarachnoid hemorrhage varies with time. To date, studies have been limited to early time points and have reported that prognostication is best after resuscitation.OBJECTIVE: To describe how prediction of outcome varies from ictus through the first week of admission.METHODS: A retrospective analysis of patients with a diagnosis of aneurysmal subarachnoid hemorrhage recruited to a prospective database. Neurological condition was recorded on each day of the inpatient stay, up to day 7, using World Federation of Neurological Societies score (WFNS). Poor outcome was defined by modified Rankin scale of 3-6 at 3 months. Outcome prediction was assessed using area under the curve (AUC) after binary logistic regression.RESULTS: Of 645 patients, 55(14%) patients with WFNS 1&2 and 77(45%) patients with WFNS 4&5 on day 0 had a poor outcome. 30(8%) patients with WFNS 1&2 and 54(81%) patients with WFNS 4&5 on day 7 had a poor outcome. Prognostication using WFNS improved from day 0 to day 7 (AUC = 70.1%, CI 65.0%–75.1% vs AUC = 81.9%, CI 77.4%–86.0%) with an incremental improvement with each day in between, and the largest increases early around the time of resuscitation.CONCLUSION: Prediction of outcome improves beyond the initial resuscitation, up to day 7 of admission, with no evidence of any deterioration around the time of treatment or delayed complications like delayed cerebral ischemia. This is important when prognosticating for clinical purposes and emphasizes the importance of standardization of timing of WFNS in research.

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e-pub ahead of print date: 21 October 2022

Identifiers

Local EPrints ID: 470987
URI: http://eprints.soton.ac.uk/id/eprint/470987
ISSN: 2633-0873
PURE UUID: b842202c-3eb7-4a29-90e1-306c0e11d3d6
ORCID for Ben Gaastra: ORCID iD orcid.org/0000-0002-7517-6882
ORCID for Diederik Bulters: ORCID iD orcid.org/0000-0001-9884-9050

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Date deposited: 24 Oct 2022 16:35
Last modified: 25 Oct 2022 01:58

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Contributors

Author: James Booker
Author: Peter Barron
Author: Laura Newitt
Author: Simran Chhugani
Author: Awais Sarwar
Author: Frederick Ewbank
Author: Ben Gaastra ORCID iD
Author: Diederik Bulters ORCID iD

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