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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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The herniation WFNS score, to predict outcome in poor grade aneurysmal subarachnoid haemorrhage patients – a prospective multicentre study

Der Herniations-WFNS Score, zur Prognoseabschätzung von Patienten mit schwerer aneurysmatischer Subarachnoidalblutung – eine prospektive Multicenter-Studie

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  • presenting/speaker Christian Fung - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Jürgen Beck - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Johannes Goldberg - Inselspital, Universitätsspital Bern, Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Bern, Schweiz
  • Jan-Karl Burkhardt - Penn Neuroscience Center, Neurosurgery, Philadelphia, PA, Vereinigte Staaten; Universitätsspital Zürich, Department of Neurosurgery, Zürich, Schweiz
  • Serge Marbacher - Kantonsspital Aarau, Neurosurgery, Aarau, Schweiz
  • Martin Seule - Kantonsspital St. Gallen, Klinik für Neurochirurgie, St. Gallen, Schweiz
  • Daniel W. Zumofen - Maimonides Medical Center, Neurosurgery, New York, NY, Vereinigte Staaten; Universitätsspital Basel, Neurochirurgie, Basel, Schweiz
  • Roy T. Daniel - Centre Hospitalier Universitaire Vaudois, Neurochirurgie, Lausanne, Schweiz
  • Philippe Bijlenga - Hopitaux Universitaires de Geneve, Department of Neurosurgery, Genf, Schweiz
  • Andreas Raabe - Inselspital, Universitätsspital Bern, Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Bern, Schweiz

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV071

doi: 10.3205/21dgnc072, urn:nbn:de:0183-21dgnc0723

Published: June 4, 2021

© 2021 Fung et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Incorporation of signs of brainstem dysfunction into the current World Federation of Neurosurgical Societies (WFNS) classification might improve outcome prediction in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods: We performed an international prospective multicenter study in poor grade aSAH patients to compare the WFNS classification with a modified WFNS classification - the herniation WFNS score (hWFNS). Here, only patients that showed signs of brainstem dysfunction were assigned hWFNS V. Outcome was assessed by modified Rankin score 6 months after hemorrhage. The primary endpoint is the difference of specificities of the WFNS and hWFNS with respect to poor outcome at 6 months after initial hemorrhage.

Results: 250 patients were included. 237 reached the primary endpoint. Comparing the pre-resuscitation and post-resuscitation WFNS and hWFNS score the specificities increased from 0.35 to 0.84 and from 0.19 to 0.93. The positive predictive value increased from 65.9 to 80.5 and 61.9 to 88.3, respectively.

Conclusion: The hWFNS score improves outcome prediction for poor grade aSAH patients by implementing signs of brainstem dysfunction into the current WFNS grading. This has major impact for daily clinical practice and decision-making and interpretation of scientific data.