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Vol. 35. Issue 1.
Pages 1-5 (January - February 2024)
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Vol. 35. Issue 1.
Pages 1-5 (January - February 2024)
Clinical Research
Prognostic value of scales for aneurysmal subarachnoid hemorrhage: Report of a reference center in Peru
Valor pronóstico de las escalas para hemorragia subaracnoidea aneurismática: reporte de un centro de referencia en Perú
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Giuseppe Rojas-Pantaa,
Corresponding author
giuseppe_r29@hotmail.com

Corresponding author at: Department of Neurosurgery, Vascular and Tumor Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Grau Avenue 800, La Victoria, Lima, Perú
, Gian F. Reyes-Narroa, Carlos Toro-Huamanchumob, Joham Choque-Velasquezc,d, Giancarlo Saal-Zapatae,f
a Departamento de Neurocirugía, Servicio de Neurocirugía Vascular y Tumores, Hospital Nacional Guillermo Almenar Irigoyen-EsSalud, Lima, Peru
b Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
c Unidad de Neurocirugía, Hospital Regional del Cusco, Cusco, Peru
d Facultad de Ciencias de la Salud, Escuela Profesional de Medicina Humana, Universidad Andina del Cusco, Cusco, Peru
e Departamento de Neurocirugía, Servicio de Neurocirugía Endovascular, Hospital Nacional Guillermo Almenar Irigoyen-EsSalud, Lima, Peru
f Clínica Angloamericana, San Isidro, Lima, Peru
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Figures (2)
Tables (3)
Table 1. Overall characteristics of the patients.
Table 2. Distribution of patients, poor clinical outcomes, and mortality between aSAH scales.
Table 3. AUC of prognostic scales for poor outcome and mortality.
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Abstract
Introduction

Multiple scales have been designed to stratify the severity and predict the prognosis in the initial evaluation of patients with aneurysmal subarachnoid hemorrhage (aSAH). Our study aimed to validate the most commonly used prognostic scales for aSAH in our population: Hunt-Hess, modified Hunt-Hess, World Federation of Neurosurgical Societies (WFNS), Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH), and Barrow Aneurysm Institute (BAI) scales.

Methods

This study includes all aSAH cases treated at our institution between June 2019 and December 2020. We developed a retrospective cohort by reviewing medical records and radiologic images performed during hospitalization. The outcome was evaluated using the modified Rankin scale (mRS). It was defined as a poor outcome (mRS 4–5) and mortality (mRS 6). The ROC curves and the area under the curve (AUC) of each of the prognostic scales were calculated to evaluate their prognostic prediction capacity.

Results

A total of 142 patients were diagnosed with aSAH. A poor outcome occurred in 52.1% of the patients, whereas mortality was 27.5%. The AUC of the scales studied was similar and no significant difference was found between them for predicting a poor outcome (P = .709) or mortality (P = .715).

Conclusion

We determined that the prognostic scales for aSAH had a similar predictive value for poor clinical outcomes and mortality in our institution, with no significant difference. Thus, we recommend the most simple and well-known scale used institutionally.

Keywords:
Scales
Aneurysm
Subarachnoid hemorrhage
Modified Rankin scale
Intracranial
Resumen
Introducción

Se han diseñado múltiples escalas para estratificar la gravedad y predecir el pronóstico en la evaluación inicial de pacientes con hemorragia subaracnoidea aneurismática (HSAa). Nuestro estudio tuvo como objetivo validar las escalas pronósticas más utilizadas para HSAa en nuestra población: Hunt-Hess, Hunt-Hess modificada, World Federation of Neurosurgical Societies (WFNS), Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH) y finalmente, la escala Barrow Aneurysm Institute (BAI).

Métodos

Este estudio incluye todos los casos de HSAa atendidos en nuestra institución entre junio de 2019 y diciembre de 2020. Desarrollamos una cohorte retrospectiva mediante la revisión de historias clínicas e imágenes radiológicas realizadas durante la hospitalización. El resultado se evaluó mediante la escala de Rankin modificada (mRS), la cual se definió como mala evolución (mRS 4–5) y mortalidad (mRS 6). Se calcularon las curvas ROC y el área bajo la curva (AUC) de cada una de las escalas pronósticas para evaluar su capacidad de predicción pronóstica.

Resultados

Un total de 142 pacientes fueron diagnosticados de HSAa. Un mal resultado se produjo en el 52.1% de los pacientes, mientras que la mortalidad fue del 27.5%. El AUC de las escalas estudiadas fue similar y no se encontró diferencia significativa entre ellas para predecir mal resultado (P = .709) o mortalidad (P = .715).

Conclusión

Determinamos que las escalas pronósticas para HSAa tuvieron un valor predictivo similar para malos resultados clínicos y mortalidad, sin diferencia significativa. Por lo tanto, recomendamos la escala más sencilla y conocida utilizada institucionalmente.

Palabras clave:
Escalas
Aneurisma
Hemorragia subaracnoidea
Escala de Rankin modificada
Intracraneal

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