Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland.
Neurosurgery. 2018 Dec 1;83(6):1286-1293. doi: 10.1093/neuros/nyx609.
The Barrow Neurological Institute (BNI) scale is a novel quantitative scale measuring maximal subarachnoid hemorrhage (SAH) thickness to predict delayed cerebral ischemia (DCI). This scale could replace the Fisher score, which was traditionally used for DCI prediction.
To validate the BNI scale.
All patient data were obtained from the prospective aneurysmal SAH multicenter registry. In 1321 patients, demographic data, BNI scale, DCI, and modified Rankin Scale (mRS) score up to the 1-yr follow-up (1FU) were available for descriptive and univariate statistics. Outcome was dichotomized in favorable (mRS 0-2) and unfavorable (mRS 3-6). Odds ratios (OR) for DCI of Fisher 3 patients (n = 1115, 84%) compared to a control cohort of Fisher grade 1, 2, and 4 patients (n = 206, 16%) were calculated for each BNI grade separately.
Overall, 409 patients (31%) developed DCI with a high DCI rate in the Fisher 3 cohort (34%). With regard to the BNI scale, DCI rates went up progressively from 26% (BNI 2) to 38% (BNI 5) and corresponding OR for DCI increased from 1.9 (1.0-3.5, 95% confidence interval) to 3.4 (2.1-5.3), respectively. BNI grade 5 patients had high rates of unfavorable outcome with 75% at discharge and 58% at 1FU. Likelihood for unfavorable outcome was high in BNI grade 5 patients with OR 5.9 (3.9-8.9) at discharge and OR 6.6 (4.1-10.5) at 1FU.
This multicenter external validation analysis confirms that patients with a higher BNI grade show a significantly higher risk for DCI; high BNI grade was a predictor for unfavorable outcome at discharge and 1FU.
巴罗神经研究所（BNI）量表是一种新的定量量表，用于测量最大蛛网膜下腔出血（SAH）厚度以预测迟发性脑缺血（DCI）。该量表可以替代传统上用于预测 DCI 的 Fisher 评分。
验证 BNI 量表。
所有患者数据均来自前瞻性动脉瘤性蛛网膜下腔出血多中心登记处。在 1321 名患者中，有描述性和单变量统计数据的人口统计学数据、BNI 量表、DCI 和改良 Rankin 量表（mRS）评分，直至 1 年随访（1FU）。结果分为有利（mRS 0-2）和不利（mRS 3-6）。分别计算每个 BNI 等级中 Fisher 3 级患者（n=1115，84%）与 Fisher 1、2 和 4 级患者（n=206，16%）对照队列的 DCI 的 Fisher 比值比（OR）。
总体而言，409 名患者（31%）发生 DCI，Fisher 3 级患者的 DCI 发生率较高（34%）。关于 BNI 量表，DCI 发生率从 BNI 2 级的 26%上升到 BNI 5 级的 38%，相应的 DCI OR 从 1.9（1.0-3.5，95%置信区间）增加到 3.4（2.1-5.3）。BNI 5 级患者的不良结局发生率较高，出院时为 75%，1FU 时为 58%。BNI 5 级患者不良结局的可能性很高，出院时的 OR 为 5.9（3.9-8.9），1FU 时的 OR 为 6.6（4.1-10.5）。
这项多中心外部验证分析证实，较高 BNI 等级的患者发生 DCI 的风险显著增加；高 BNI 等级是出院和 1FU 时不良结局的预测因子。
