Comparing radiographic scores for prediction of complications and outcome of aneurysmal subarachnoid hemorrhage: Which performs best?

Abstract

Background and purpose Aneurysmal subarachnoid hemorrhage (aSAH) is characterized by high morbidity and mortality proceeding from the initial severity and following complications of aSAH. Various scores have been developed to predict these risks. We aimed to analyze the clinical value of different radiographic scores for prognostication of aSAH outcome. Methods Initial computed tomography scans (≤48 h after ictus) of 745 aSAH cases treated between January 2003 and June 2016 were reviewed with regard to Subarachnoid Hemorrhage Early Brain Edema Score (SEBES), and Claassen, Barrow Neurological Institute (BNI), Hijdra, original Graeb and Fisher scale scores. The primary endpoints were development of delayed cerebral ischemia (DCI), in‐hospital mortality and unfavorable outcome (modified Rankin Scale score >3) at 6 months after subarachnoid hemorrhage. Secondary endpoints included the different complications that can occur during aSAH. Clinically relevant cutoffs were defined using receiver‐operating characteristic curves. The radiographic scores with the highest values for area under the curve (AUC) were included in the final multivariate analysis. Results The Hijdra sum score had the most accurate predictive value and independent associations with all primary endpoints: DCI (AUC 0.678, adjusted odds ratio [aOR] 2.83; p < 0.0001); in‐hospital mortality (AUC 0.704, aOR 2.83; p < 0.0001) and unfavorable outcome (AUC 0.726, aOR 2.91; p < 0.0001). Multivariate analyses confirmed the independent predictive value of the radiographic scales for risk of decompressive craniectomy (SEBES and Fisher score), cerebral vasospasm (SEBES, BNI score and Fisher score) and shunt dependency (Hijdra ventricle score and Fisher score) after aSAH. Conclusions Initial radiographic severity of aSAH was independently associated with occurrence of different complications during aSAH and the final outcome. The Hijdra sum score showed the highest diagnostic accuracy and robust predictive value for early detection of risk of DCI, in‐hospital mortality and unfavorable outcome after aSAH.

The value of modified hijdra score in patients with aneurysmal subarachnoid hemorrhage

“…The modified Fisher score showed a significant difference between aneurysmal and non-aneurysmal patients [ 14 ]; however, there was poor interobserver agreement [ 15 ]. In contrast, the modified Hijdra score exhibits better interobserver agreement [ 2 , 16 ] and provides an independent assessment of 10 brain pools or fissures. This makes the modified Hijdra score more user-friendly in clinical applications while maintaining a higher diagnostic efficacy compared to the Hijdra score.…”

“…Aneurysmal subarachnoid hemorrhage (aSAH) is a critical neurosurgical emergency with high disability and mortality, primarily due to the initial severity and subsequent complications [ 1 , 2 ]. Accurate aneurysms diagnosis is crucial [ 2 , 3 ]. Aneurysms are abnormal arterial formations within the cranial cavity.…”

“…Yet, these methods have limitations: invasiveness with associated risks, prolonged duration and higher costs, and potential failure in detecting small lesions, inpending timely diagnosis. Notably, about 15%–20% of non-traumatic SAH patients show no vascular abnormalities on cerebral angiography [ 2 , 4 , 5 ], but repeat angiography in CT-negative cases detects vascular lesions in 13%, and aneurysms or pseudoaneurysms in 4% [ [6] , [7] , [8] ]. Nonaneurysmal SAH diagnosis requires excluding other causes through invasive and noninvasive tests, including angiography, CT, and MRI.…”

“…The Hijdra score is a quantifies subarachnoid hemorrhage volume from CT findings, assessing 10 brain pools/splits and 4 ventricles, with scores ranging 0 to 3. Initially used for baseline assessment and prediction of outcomes [ 9 , 10 ], the score has shown improved interobserver agreement [ 2 , 6 ]. In 2020, Kole et al demonstrated that the Hijdra score's utility in diagnosing SAH patients with cerebral angiography-detected aneurysms and developed a model predicting aneurysm risk in nontraumatic SAH patients [ 3 ].…”

Navigating through the paradox of choice: prediction of outcome in aneurysmal subarachnoid hemorrhage

“…The Hemorrhage, Age, Treatment, Clinical State, Hydrocephalus (HATCH) score has also been externally validated for prediction of functional outcome [ 13 ]. Among purely radiological scores, the Hijdra sum score outperformed the Subarachnoid Hemorrhage Early Brain Edema Score (SEBES), Fischer, Claassen, Barrow Neurological Institute (BNI), and original Graeb scales in prediction of DCI, mortality and poor outcome of SAH [ 14 ]. With the ever increasing footprint of artificial intelligence in medicine, a number of predictive models have been formulated using machine learning tools in the recent past [ 15 ].…”