Predicting long-term outcome in poor grade aneurysmal subarachnoid haemorrhage patients utilising the Glasgow Coma Scale |
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| Authors: | Robert M Starke Ricardo J Komotar Marc L Otten J Michael Schmidt Luis D Fernandez Fred Rincon Errol Gordon Neeraj Badjatia Stephan A Mayer E Sander Connolly |
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| Institution: | 1. Melbourne Brain Centre, The University of Melbourne, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia;2. The University of Melbourne, Department of Radiology, The Royal Melbourne Hospital, Melbourne, VIC, Australia;3. National Stroke Research Unit, Florey Neuroscience Institute, Melbourne, VIC, Australia;4. NeuroIntervention Service, The Royal Melbourne Hospital, Melbourne, VIC, Australia;1. Department of Neurology, Charité–Universitätsmedizin, Berlin, Germany;2. Department of Radiology, Charité–Universitätsmedizin, Berlin, Germany;3. Center of Stroke Research, Berlin, Germany.;1. University Hospital, Department of Neuroradiology, 2 rue H. Le Guillou, Hôpital Pontchaillou, CHU Rennes, 35000 Rennes, France;2. University Hospital, Department of Neurology, 2 rue H. Le Guillou, Hôpital Pontchaillou, CHU Rennes, 35000 Rennes, France;3. VISAGES U746 Unit INSERM-INRIA, IRISA UMR CNRS 6074, Université Rennes 1, Campus Beaulieu, 35000 Rennes, France;4. University Hospital, Emergency Department, 2 rue H. Le Guillou, Hôpital Pontchaillou, CHU Rennes, 35000 Rennes, France;1. Department of Radiology, Division of Interventional Neuroradiology, University of Maryland, 22 South Greene Street, Baltimore, MD 21201.;2. Department of Neurology, University of Maryland, 22 South Greene Street, Baltimore, MD 21201.;1. Department of Neurology, Comprehensive Stroke Center, University Hospital Olomouc, I. P. Pavlova 6, 77520 Olomouc, Czech Republic;2. Department of Radiology, Comprehensive Stroke Center, University Hospital Olomouc, I. P. Pavlova 6, 77520 Olomouc, Czech Republic;3. Department of Neurology, Palacký University Medical School, Olomouc, Czech Republic;4. Department of Medical Biophysics, Palacký University Medical School, Olomouc, Czech Republic |
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| Abstract: | The Glasgow Coma Scale (GCS) is the most universally accepted system for grading level of consciousness. Predicting outcome is particularly difficult in poor grade aneurysmal subarachnoid haemorrhage (aSAH) patients. We hypothesised that the GCS and individual examination components would correlate with long-term outcome and have varying prognostic value depending on assessment time points. GCS scores of 160 aSAH patients presenting in stupor or coma were prospectively recorded on admission and each subsequent day until hospital day 14. Early treatment was planned for each patient unless the patient’s family refused aggressive intervention or the patient died before surgery. Outcomes were assessed by the modified Rankin scale (mRS) at 14 days, 3 months, and one year.All patients who did not receive surgical treatment died within one year. Of the 104 patients who received surgical treatment, 13.5% of them had a favourable outcome at 14 days, 38.5% at 3 months, and 51% at one year (p < 0.0001). Admission GCS scores significantly correlated with outcome (Spearman rank test, rs = 0.472, p < 0.0001). On admission, motor examination correlated best with one-year outcome (rs = 0.533, p < 0.0001). Each point increase in motor examination predicted a 1.8-fold increased odds of favourable long-term outcome (95% confidence interval CI], 1.4–2.3). At discharge, eye examination (rs = 0.760, p < 0.0001) correlated best with one-year outcome, and a one point increase in eye examination predicted a 3.1-fold increased odds of favourable outcome (95% CI, 1.8–5.4). During hospitalisation, the best eye exam (rs = 0.738, p < 0.0001) and worst motor exam (rs = 0.612, p < 0.0001) were the most highly correlated with the one-year outcome.Long-term follow-up is necessary when evaluating recovery after aSAH, as outcomes improve significantly during the first year. The GCS and its individual components correlate well with long-term outcome. Admission motor examination and spontaneous eye opening during hospitalisation are most predictive of favourable recovery. |
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