Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin.
Department of Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.
Eur J Neurol. 2018 Jan;25(1):111-119. doi: 10.1111/ene.13471. Epub 2017 Nov 2.
There are numerous grading scales to describe the severity of aneurysmal subarachnoid hemorrhage (aSAH) and to predict outcome. Historically, outcome measures are heterogeneous and the comparability of grading scales is therefore limited. We designed this study to compare radiographic, clinical and combined grading systems in aSAH.
Data from 423 consecutive patients with aSAH were analyzed. Modified Fisher (mFish), Barrow Neurological Institute (BNI), Hunt and Hess (HH), World Federation of Neurosurgical Societies (WFNS), VASOGRADE (VG) and HAIR scores were calculated from clinical and radiographic data or the combination of both. Outcome measures included the development of new cerebral infarction (CI) and functional patient outcome assessed by the modified Rankin scale.
Cerebral infarction and unfavorable outcome were predicted by radiographic, clinical and combined measures (each with P ≤ 0.001). Clinical (HH, WFNS) and combined (VG, HAIR) scores had superior predictive power for CI compared with mFish grading but not BNI [area under the curve (AUC) 0.612, AUC 0.616, AUC 0.672, AUC 0.673, AUC 0.674, AUC 0.638]. Predictive performances of clinical gradings (HH, WFNS) for patient outcome were superior to radiographic measures and of similar quality or better than combined systems (AUC 0.628, AUC 0.654, AUC 0.736, AUC 0.749, AUC 0.711, AUC 0.739).
Knowledge of the merits and limitations of clinical, radiographic and combined scores is necessary in routine clinical practice. The new combined grading systems (HAIR, VG) showed no superiority compared with the established clinical measures (WFNS, HH) in predicting CI and unfavorable patient outcome.
有许多分级量表可用于描述蛛网膜下腔出血（aSAH）的严重程度和预测预后。历史上，预后评估指标各不相同，因此分级量表的可比性有限。我们设计本研究旨在比较 aSAH 的影像学、临床和联合分级系统。
分析了 423 例连续的 aSAH 患者的数据。从临床和影像学数据或两者的组合中计算出改良 Fisher（mFish）、巴罗神经研究所（BNI）、Hunt 和 Hess（HH）、世界神经外科学会联合会（WFNS）、VASOGRADE（VG）和 HAIR 评分。预后指标包括新发脑梗死（CI）的发生和采用改良 Rankin 量表评估的功能患者结局。
影像学、临床和联合评估（每项 P≤0.001）均预测脑梗死和不良预后。临床（HH、WFNS）和联合（VG、HAIR）评分对 CI 的预测能力优于 mFish 分级，但不如 BNI [曲线下面积（AUC）0.612、AUC 0.616、AUC 0.672、AUC 0.673、AUC 0.674、AUC 0.638]。临床分级（HH、WFNS）对患者结局的预测性能优于影像学指标，且与联合系统的质量相当或更好（AUC 0.628、AUC 0.654、AUC 0.736、AUC 0.749、AUC 0.711、AUC 0.739）。
在常规临床实践中，需要了解临床、影像学和联合评分的优缺点。新的联合分级系统（HAIR、VG）在预测 CI 和不良患者结局方面与既定的临床措施（WFNS、HH）相比没有优势。
