gms | German Medical Science

Objective: Today WFNS grading scale is used to estimate the severity of subarachnoid hemorrhage (SAH) and to forecast ultimate outcome. Early neurological improvement as well as deterioration is common. A standardized time interval for clinical grading of SAH appears therefore mandatory. In this study we correlated the neurological course within the first 72 hours after admission with outcome.

Methods: Prospectively acquired data of 489 patients with aneurysmal SAH admitted to hospital between 2004 and 2009 were analysed. WFNS grade was determined six times within the first 72 hours. Fisher score was determined at admission. Outcome was assessed by Rankin score at time of discharge. We correlated all clinical grades with outcome. Statistical correlation was computed by χ²-test.

Results: 62 patients (12.6%) improved from a poor WFNS grade (IV or V) to a good WFNS grade (WFNS I or II) within 72 hours. Improvement occurred after drainage of hydrocephalus (n=24), recovering from initial seizure (n=33) or evacuation of intracerebral hematoma (n=5). 18 patients (3.7%) deteriorated in this period from good WFNS grade to poor WFNS grade due to cerebral infarction (n=7), rebleeding (n=6) or systemic complications (n=5). Outcome was best predicted by the WFNS grade measured within 36 to 48 hours after admission (r=0,832). Fisher grade and the initial WFNS correlated with outcome less closely (Fisher r=0,397, initial WFNS r=0,616).

Conclusions: With regard to a more reliable outcome prediction we propose to select the WFNS grade during the time period 36-48 hours after admission as the basis for assessment.