Sagues Elena, Gudino Andres, Dier Carlos, Aamot Connor, Samaniego Edgar A
Department of Neurology, University of Iowa, 200, Hawkins Drive, Iowa City, IA, USA.
Department of Radiology, University of Iowa, 200, Hawkins Drive, Iowa City, IA, USA.
Transl Stroke Res. 2025 Feb;16(1):25-36. doi: 10.1007/s12975-024-01284-3. Epub 2024 Jul 29.
Despite advancements in acute management, morbidity rates for subarachnoid hemorrhage (SAH) remain high. Therefore, it is imperative to utilize standardized outcome scales in SAH research for evaluating new therapies effectively. This review offers a comprehensive overview of prevalent scales and clinical outcomes used in SAH assessment, accompanied by recommendations for their application and prognostic accuracy. Standardized terminology and diagnostic criteria should be employed when reporting pathophysiological outcomes such as symptomatic vasospasm and delayed cerebral ischemia. Furthermore, integrating clinical severity scales like the World Federation of Neurosurgical Societies scale and modified Fisher score into clinical trials is advised to evaluate their prognostic significance, despite their limited correlation with outcomes. The modified Rankin score is widely used for assessing functional outcomes, while the Glasgow outcome scale-extended version is suitable for broader social and behavioral evaluations. Avoiding score dichotomization is crucial to retain valuable information. Cognitive and behavioral outcomes, though frequently affected in patients with favorable neurological outcomes, are often overlooked during follow-up outpatient visits, despite their significant impact on quality of life. Comprehensive neuropsychological evaluations conducted by trained professionals are recommended for characterizing cognitive function, with the Montreal Cognitive Assessment serving as a viable screening tool. Additionally, integrating psychological inventories like the Beck Depression and Anxiety Inventory, along with quality-of-life scales such as the Stroke-Specific Quality of Life Scale, can effectively assess behavioral and quality of life outcomes in SAH studies.
尽管在急性治疗方面取得了进展，但蛛网膜下腔出血（SAH）的发病率仍然很高。因此，在SAH研究中使用标准化的结局量表以有效评估新疗法势在必行。本综述全面概述了SAH评估中常用的量表和临床结局，并对其应用和预后准确性提出了建议。在报告症状性血管痉挛和迟发性脑缺血等病理生理结局时，应采用标准化的术语和诊断标准。此外，建议将世界神经外科协会联合会量表和改良Fisher评分等临床严重程度量表纳入临床试验，以评估其预后意义，尽管它们与结局的相关性有限。改良Rankin量表广泛用于评估功能结局，而格拉斯哥结局量表扩展版适用于更广泛的社会和行为评估。避免对分数进行二分法处理对于保留有价值的信息至关重要。认知和行为结局虽然在神经功能良好的患者中经常受到影响，但在门诊随访中往往被忽视，尽管它们对生活质量有重大影响。建议由训练有素的专业人员进行全面的神经心理学评估以表征认知功能，蒙特利尔认知评估可作为一种可行的筛查工具。此外，将贝克抑郁和焦虑量表等心理量表以及卒中特异性生活质量量表等生活质量量表纳入其中，可以有效评估SAH研究中的行为和生活质量结局。
