Evaluation of a revised Glasgow Coma Score scale in predicting long-term outcome of poor grade aneurysmal subarachnoid hemorrhage patients |
| |
| Authors: | Robert M Starke Ricardo J Komotar Grace H Kim Christopher P Kellner Marc L Otten David K Hahn J Michael Schmidt Robert R Sciacca Stephan A Mayer E Sander Connolly |
| |
| Institution: | 2. Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado;1. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI;2. Department of Medicine, Rush University Medical Center, Chicago, IL;3. Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children''s Hospital, and Houston Methodist Hospital, Houston, TX;4. Division of Hematology and Oncology, Houston Methodist Cancer Center, Houston, TX;5. Division of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, IL;1. John Theurer Cancer Center, Hackensack, NJ;2. Department of Hematology/Oncology, Columbia University Medical Center, New York, NY;3. Department of Hematology/Oncology, Jefferson University Hospital, Philadelphia, PA;4. Pharmacyclics, Inc, Sunnyvale, CA;1. WFNS Cerebrovascular Diseases and Therapy Committee;2. Biostatistics and Clinical Epidemiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama-shi, Japan;3. Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake, Japan;4. Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran;5. Department of Neurosurgery, COMS Bharatpur, Bharatpur, Nepal;6. Science Council, Japan Neurosurgical Society, Tokyo, Japan |
| |
| Abstract: | Although many scales attempt to predict outcome following aneurysmal subarachnoid hemorrhage (aSAH), none have achieved universal acceptance, and most scales in common use are not statistically derived. We propose a statistically validated scale for poor grade aSAH patients that combines the Hunt and Hess grades and the Glasgow Coma Scale (GCS) scores; we refer to this as the Poor Grade GCS (PGS).The GCS scores of 160 poor grade aSAH patients (Hunt and Hess Grades 4 and 5) were recorded throughout their hospital stay. Outcomes were assessed by the modified Rankin scale (mRS). Analysis of variance and the Chi-square test were used to guide an analysis of GCS breakpoints according to outcomes. Multivariable logistic regression analysis was used to assess the ability of the Hunt and Hess, GCS, World Federation of Neurological Surgeons Grading Scale, and the PGS to predict long-term outcome.Outcome analysis revealed significant breakpoints in admission GCS scores: PGS-A (GCS 10–12); PGS-B (GCS 8–9); PGS-C (GCS 5–7); PGS-D (GCS 3–4) (p < 0.001). In surgical patients, 95.2% of PGS-A, 58.1% of PGS-B, 35.4% of PGS-C, and 28.6% of PGS-D had a favorable one-year outcome. When controlling for age, sex, and operation status, PGS was the only scale predictive of long-term outcome. The odds ratios (OR) for unfavorable outcome according to PGS admission scores (with PGS-A as the reference) were: PGS-B, OR = 14.2 (95% CI 1.5–140.5); PGS-C, OR = 38.5 (95% CI 4.2–340.0); and PGS-D, OR = 63.4 (95% CI 5.6–707.1). In addition to PGS admission scores, an age of 70 or greater was a significant predictor of poor outcome with an OR of 7.5 (95% CI 1.8–30.7). No patients with a PGS-C or PGS-D over the age of 70 had a favorable long-term outcome.Therefore, elements of the Hunt and Hess and GCS can be combined into the PGS to predict long-term outcome in poor grade aSAH patients. However, patients with PGS-C and PGS-D over the age of 70 should be assessed carefully prior to definitive treatment. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
