gms | German Medical Science

Objective: Despite cerebral vasospasm early brain injury (EBI) is a major cause of high mortality and poor prognosis in patients with subarachnoid hemorrhage (SAH). A key feature of EBI is cerebral edema. The Subarachnoid hemorrhage Early Brain Edema Score (SEBES) is a semiquantitative score to measure cerebral edema in cranial CT and correlates with the outcome in patients with SAH [1].

Because SEBES is based on the absence of visible sulci on only two defined CT-levels, we hypothesized that the predictive value of SEBES could be improved through an additional CT-level.

Methods: We analysed retrospectively all prospectively collected patients with a non-traumatic SAH who were admitted between January 2011 to February 2017 (n=668). Patients with an initial CT later than 12 hours after ictus were excluded. Cerebral edema was measured with SEBES1 and with a modified SEBES (mSEBES). The mSEBES includes the two CT-levels of SEBES and a CT-level which is located 2 cm below the skull. We defined 0–4 points as low-grade and 5–6 points as high-grade mSEBES. Clinical outcome was measured with a modified Rankin Scale (mRS) six months after ictus. We defined mRS≤2 as good outcome and mRS≥3 as poor outcome.

Results: A total of 300 patients were analysed. Patients with high-grade mSEBES had delayed cerebral ischemia (DCI more often) than patients with low-grade mSEBES (p<0.00001).

Six months after SAH, patients with low-grade mSEBES in initial CT had a significantly better outcome (mean mRS of 2.1) than patients with high-grade mSEBES (mean mRS of 4; p<0.00001). Furthermore, a Receiver-Operating-Characteristic (ROC) Curve Analyses showed that mSEBES (three CT-levels) predicts the clinical outcome better than SEBES (two levels; p<0.0001).

Conclusion: EBI is associated with an unfavourable outcome. The mSEBES is more suitable to predict outcome after SAH than SEBES. In the future mSEBES should be used to measure cerebral edema und to predict the outcome of patients with SAH.