Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea.
BMJ Open. 2019 Feb 20;9(2):e024007. doi: 10.1136/bmjopen-2018-024007.
To develop new nomograms by adding ECG changes (ST depression or tall T wave) and age to three conventional scoring systems, namely, World Federation of Neurosurgical Societies (WFNS) scale, Hunt and Hess (HH) system and Fisher scale, that can predict prognosis in patients with subarachnoid haemorrhage (SAH) using our preliminary research results and to perform external validation of the three new nomograms.
Retrospective, observational study SETTING: Emergency departments (ED) of two university-affiliated tertiary hospital between January 2009 and March 2015.
Adult patients with SAH were enrolled. Exclusion criteria were age <19 years, no baseline ECG, cardiac arrest on arrival, traumatic SAH, referral from other hospital and referral to other hospitals from the ED.
The 6 month prognosis was assessed using the Glasgow Outcome Scale (GOS). We defined a poor outcome as a GOS score of 1, 2 or 3.
A total of 202 patients were included for analysis. From the preliminary study, age, ECG changes (ST depression or tall T wave), and three conventional scoring systems were selected to predict prognosis in patients with SAH using multi-variable logistic regression. We developed simplified nomograms using these variables. Discrimination of the developed nomograms including WFNS scale, HH system and Fisher scale was superior to those of WFNS scale, HH system and Fisher scale (0.912 vs 0.813; p<0.001, 0.913 vs 0.826; p<0.001, and 0.885 vs 0.746; p<0.001, respectively). The calibration plots showed excellent agreement. In the external validation, the discrimination of the newly developed nomograms incorporating the three scoring systems was also good, with an area under the receiver-operating characteristic curve value of 0.809, 0.812 and 0.772, respectively.
We developed and externally validated new nomograms using only three independent variables. Our new nomograms were superior to the WFNS scale, HH systems, and Fisher scale in predicting prognosis and are readily available.
在我们的初步研究结果的基础上，通过增加心电图改变（ST 段压低或高大 T 波）和年龄，对世界神经外科学会（WFNS）分级、Hunt 和 Hess（HH）分级和 Fisher 分级这三种传统评分系统进行改良，建立预测蛛网膜下腔出血（SAH）患者预后的新的列线图，并对三种新的列线图进行外部验证。
回顾性观察性研究
2009 年 1 月至 2015 年 3 月期间，两家大学附属医院的急诊科（ED）。
纳入成年 SAH 患者。排除标准为年龄<19 岁、无基线心电图、入院时心搏骤停、外伤性 SAH、来自其他医院的转诊以及从 ED 转至其他医院。
采用格拉斯哥预后量表（GOS）评估 6 个月预后。我们将预后不良定义为 GOS 评分 1、2 或 3。
共纳入 202 例患者进行分析。通过多变量逻辑回归，从初步研究中选择年龄、心电图改变（ST 段压低或高大 T 波）和三种传统评分系统来预测 SAH 患者的预后。我们使用这些变量开发了简化的列线图。包括 WFNS 分级、HH 系统和 Fisher 分级的改良列线图的判别能力优于 WFNS 分级、HH 系统和 Fisher 分级（0.912 比 0.813；p<0.001，0.913 比 0.826；p<0.001，0.885 比 0.746；p<0.001）。校准图显示出良好的一致性。在外部验证中，新开发的纳入三种评分系统的列线图的判别能力也较好，受试者工作特征曲线下面积分别为 0.809、0.812 和 0.772。
我们仅使用三个独立变量开发和外部验证了新的列线图。与 WFNS 分级、HH 系统和 Fisher 分级相比，我们的新列线图在预测预后方面表现更好，且易于获取。
