Artikel
The S-Score is a tool for early prediction of neurological outcome in patients with aneurysmatic subarachnoid haemorrhage
Der S-Score ist ein Tool zur frühen Prognoseeinschätzung des neurologischen Outcomes bei Patienten mit aneurysmatischer Subarachnoidalblutung
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Autoren
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Martin Grutza
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Johannes Walter
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Andreas W. Unterberg
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Klaus Zweckberger
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
Text
Objective: Aneurysmatic subarachnoid hemorrhage (aSAH) is frequently associated with a prolonged stay on the intensive care unit (ICU) and poor prognosis, which generates the need of early predictors of clinical course and functional outcome in order to improve treatment decisions and counselling of pantients and their relatives. As delayed cerebral ischemia is a major contributor to unfavorable outcome and usually occurs relatively early within the ICU stay, we designed a grading score, the S-Score, which is based on the extent of vasospasm and evaluated its correlation with clinical outcome.
Methods: In total, 204 patients with aSAH and digital subtraction angiographies performed before and at least once after the aneurysm securing procedure were included in our study. The S-Score was analysed based on the severity of angiographic cerebral vasospasm in the anterior, medial and posterior cerebral arteries (ACA, MCA and PCA) as well as the internal carotid and basilar artery (ACI and BA). One, two and three Points were awarded for vessel narrowings of <30%, 30%-50% or >50%, respectively. Points awarded for spasms in A1, M1, P1, ACI and BA were multiplied by 2. The total score was obtained by adding the determined values. The primary outcome parameter was a modified Rankin Score (MRS) >3 at the first follow up (15,5 Months+/-0,75). Spearman Correlation and Receiver Operating Characteristic (ROC) analyses were used to assess predictive value and to determine optimal cut-off scores.
Results: Unfavorable outcome occurred in 139 (69%) patients at ICU discharge and 75 (38%) patients at the first follow up. Spearman Correlation analysis showed a significant correlation between higher S-Scores and poor outcome at ICU discharge (p=0,001) and at the first follow up (p=0,001). ROC analysis revealed an area under the curve (AUC) for the correlation of unfavorable outcome at the first follow up and the S-Score of 0,79 (95% confidence interval [CI] 0.73-0.87). Using an S-Score cut-off of, e.g., 10 points yielded a sensitivity of 75,4% and a specificity of 74,7 %.
Conclusion: This study demonstrates, that higher S-Scores are associated with poor functional outcome in patients with aSAH; therefore, it could be a valuable tool for guiding of treatment decisions and counselling of patients and their relatives in the acute phase after aSAH.
