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Publications

Journal Article Multicenter Study Ppublish

PubMed: 39910723 DOI: 10.1111/acem.15121

Which grading system better predicts 28-day mortality in nontraumatic subarachnoid hemorrhage: Traditional clinical scores or combined grading systems?

Acad Emerg Med 32(5):498-505

Authors: Adem Az, Ozgur Sogut, Ertugrul Altinbilek, Irem Yildirim Oral, Mustafa Calik, Merve Metiner, Abuzer Coskun, Burak Demirci, Ramazan Guven, Ertugrul Altug, Burcu Durmus, Nihat Mujdat Hokenek, Eymen Tekedereli

Affiliations

  • Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Türkiye.
  • Department of Emergency Medicine, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye.
  • Department of Emergency Medicine, University of Health Sciences, Gaziosmanpaşa Training and Research Hospital, Istanbul, Türkiye.
  • Department of Emergency Medicine, University of Health Sciences, Bağcılar Training and Research Hospital, Istanbul, Türkiye.
  • Department of Emergency Medicine, University of Health Sciences, Istanbul Cam and Sakura City Hospital, Istanbul, Türkiye.
  • Department of Emergency Medicine, University of Health Sciences, Taksim Training and Research Hospital, Istanbul, Türkiye.

Abstract

BACKGROUND

The objective was to investigate the predictive ability of traditional clinical, radiological scores, and combined grading systems for 28-day mortality in patients with nontraumatic subarachnoid hemorrhage (SAH).

METHODS

This multicenter cohort study enrolled 451 adults who presented to the emergency departments of six major tertiary care hospitals in Istanbul with nontraumatic aneurysmal SAH. Demographic data; clinical characteristics; and traditional clinical grading scores were recorded, including the Glasgow Coma Scale (GCS), Hunt and Hess scale (HHS), World Federation of Neurological Surgeons (WFNS) scale, modified Fisher scale (mFS), and two combined grading systems, the VASOGRADE and Ogilvy-Carter scales. These data were compared between survivors and nonsurvivors.

RESULTS

A total of 451 patients were included, comprising 242 males (53.7%) and 209 females (46.3%), with a mean ± SD age of 54.8 ± 14.1 years. The overall mortality rate was 28.2% (n = 127). Nonsurvivors had significantly lower mean GCS scores and higher HHS, WFNS, mFS, and Ogilvy-Carter scores compared to survivors (all p < 0.001). A significantly higher proportion of nonsurvivors were categorized in the red group based on VASOGRADE (p < 0.001). Multivariable logistic regression analysis identified age, sex, HHS, mFS, WFNS, and VASOGRADE as independent predictors of mortality. The WFNS scale emerged as the most reliable predictor of mortality with an area under the curve of 0.878.

CONCLUSIONS

Although the GCS and Ogilvy-Carter scales effectively distinguished survivors from nonsurvivors, they were not independent predictors of mortality. The WFNS scale was identified as the most reliable predictor of mortality in aneurysmal SAH patients, followed by the mFS and HHS.

MeSH

Mortality, Hemorrhage, Subarachnoid Hemorrhage