The Barrow Neurological Institute Grading Scale as a Predictor for Delayed Cerebral Ischemia and Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From a Nationwide Patient Registry (Swiss SOS)

Abstract

Objective: To analyze the Barrow Neurological Institute (BNI) grading scale, a quantitative scale measuring maximal subarachnoid hemorrhage thickness on axial computed tomography, on delayed cerebral ischemia (DCI) and outcome (modified Rankin scale; mRS) at discharge and 1-year follow-up (1FU) in patients with aneurysmal subarachnoid hemorrhage (aSAH) from a nationwide SAH registry. Methods All patient data was obtained from the Swiss nationwide multicentre registry database of aSAH (Swiss SOS). In 1321 patients demographic data, BNI scale, DCI and mRS up to the 1FU were available for descriptive and univariate statistics. Outcome was dichotomized in favorable (mRS 0-2) and unfavorable (mRS 3-6). Odds ratios (OR) for DCI of Fisher 3 patients (n=1115, 84%) compared to a control cohort of Fisher grade 1,2 and 4 patients (n=206, 16%) were calculated for each BNI grade separately. Results Overall, 409 patients (31 %) developed DCI with a high DCI rate in the Fisher 3 cohort (34%). For what concerns the BNI scale, DCI rates went up progressively from 26% (BNI 2) to 38% (BNI 5

New risk score of the early period after spontaneous subarachnoid hemorrhage: For the prediction of delayed cerebral ischemia

“…Additionally, all CT grades were evaluated by two blinded senior neurologists. The DCI rates in our study were 27.9% in the cohort, which is consistent with other studies (21.0%-31.2% 7,12,16,20,21,26 ). To limit the potential confounders, we excluded patients whose SAH onset was more than 3 days before obtaining a CT scan to ensure the timing of the evaluation of each Abbreviations: CI, confidence interval; DCI, delayed cerebral ischemia; OR, odds ratio.…”

“…Large evidence proved higher mFS was a significant risk factor for DCI . Additionally, among the aSAH patients, a higher WFNS score at admission was considered a risk factor for DCI . The “WFNS” factor is derived from GCS score and focuses on signs and symptoms of SAH patients to reflect the primary brain injury at admission .…”

“…12,19,20 Additionally, among the aSAH patients, a higher WFNS score at admission was considered a risk factor for DCI. 7,20,21 The "WFNS" factor is derived from GCS score and focuses on signs and symptoms of SAH patients to reflect the primary brain injury at admission. 8 It is widely applied in many combined scores, such as VG 12…”

Early permanent cerebrospinal fluid diversion lowers the rate of nosocomial meningitis in aneurysmal subarachnoid hemorrhage

“…This may be because DCI is already largely predicted by other, known factors, including initial blood clot burden and DCVS (Table 3 and Fig. 3A and B) [44].…”

Screening tools for early neuropsychological impairment after aneurysmal subarachnoid hemorrhage

“…Information on complications, particularly hydrocephalus, cerebral vasospasm (CVS), DCI and disability outcome (mRS) were extracted from the institutional patient registry [16] or added by their retrospective chart review as needed. Case-severity of aSAH was defined by the World Federation of Neurosurgical Societies (WFNS) grading scale [17] and the amount of cisternal hemorrhage (Barrow Neurological Institute (BNI) scale [18]). In addition, treatment modality (microsurgical (clipping) vs. endovascular (coiling)) was recorded.…”