Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Stroke Research Centre, University College London, Institute of Neurology, London, United Kingdom.
Neurosurgery. 2020 Dec 15;88(1):96-105. doi: 10.1093/neuros/nyaa316.
The Barrow Neurological Institute (BNI) score, measuring maximal thickness of aneurysmal subarachnoid hemorrhage (aSAH), has previously shown to predict symptomatic cerebral vasospasms (CVSs), delayed cerebral ischemia (DCI), and functional outcome.
To validate the BNI score for prediction of above-mentioned variables and cerebral infarct and evaluate its improvement by integrating further variables which are available within the first 24 h after hemorrhage.
We included patients from a single center. The BNI score for prediction of CVS, DCI, infarct, and functional outcome was validated in our cohort using measurements of calibration and discrimination (area under the curve [AUC]). We improved it by adding additional variables, creating a novel risk score (measure by the dichotomized Glasgow Outcome Scale) and validated it in a small independent cohort.
Of 646 patients, 41.5% developed symptomatic CVS, 22.9% DCI, 23.5% cerebral infarct, and 29% had an unfavorable outcome. The BNI score was associated with all outcome measurements. We improved functional outcome prediction accuracy by including age, BNI score, World Federation of Neurologic Surgeons, rebleeding, clipping, and hydrocephalus (AUC 0.84, 95% CI 0.8-0.87). Based on this model we created a risk score (HATCH-Hemorrhage, Age, Treatment, Clinical State, Hydrocephalus), ranging 0 to 13 points. We validated it in a small independent cohort. The validated score demonstrated very good discriminative ability (AUC 0.84 [95% CI 0.72-0.96]).
We developed the HATCH score, which is a moderate predictor of DCI, but excellent predictor of functional outcome at 1 yr after aSAH.
巴罗神经学研究所（BNI）评分，测量蛛网膜下腔出血（aSAH）的最大厚度，先前已显示可预测症状性脑血管痉挛（CVSs）、迟发性脑缺血（DCI）和功能结局。
验证 BNI 评分对上述变量和脑梗死的预测能力，并通过整合出血后 24 小时内可用的进一步变量来评估其改善情况。
我们纳入了单中心的患者。使用校准和区分度（曲线下面积 [AUC]）的测量值，在我们的队列中验证了 BNI 评分对 CVS、DCI、梗死和功能结局的预测能力。我们通过添加额外的变量来改进它，创建了一个新的风险评分（通过二分格拉斯哥预后量表衡量），并在一个小的独立队列中进行了验证。
在 646 名患者中，41.5%发生症状性 CVS，22.9%发生 DCI，23.5%发生脑梗死，29%预后不良。BNI 评分与所有结局测量均相关。我们通过纳入年龄、BNI 评分、世界神经外科学会联合会、再出血、夹闭和脑积水等变量，提高了功能结局预测的准确性（AUC 0.84，95%CI 0.8-0.87）。基于该模型，我们创建了一个风险评分（HATCH-出血、年龄、治疗、临床状态、脑积水），范围为 0 至 13 分。我们在一个小的独立队列中进行了验证。验证后的评分显示出非常好的区分能力（AUC 0.84 [95%CI 0.72-0.96]）。
我们开发了 HATCH 评分，它是 DCI 的中度预测因子，但对 aSAH 后 1 年的功能结局是极好的预测因子。
