Abstract Details

Title The SAH Score: An Outcome Prediction Model

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S12 - (-)

Poster/Presentation
Number 004

Objective

Background The Hunt & Hess Grade and WFNS scale are commonly used to predict mortality following aneurysmal subarachnoid hemorrhage (aSAH).

Design/Methods Prospectively collected data of aSAH patients admitted to our institution between 1991-2009 were reviewed. We analyzed factors impacting in-hospital SAH mortality using multiple logistic regression analysis. Scores were 'weighted' based on relative risk of mortality following stratification of each of these variables. GCS was subdivided into subgroups of 3-4, 5-8, 9-13 and 14-15; age was split into 4 subgroups: 18-49, 50-69, 70-79 and >80. Medical co-morbidities were subdivided into none, 1 or >/=2 based on co-morbidities derived from Charlson index or other factors (hypertension, cocaine) historically known to impact SAH outcomes.

Results 1134 patients were included; all-cause SAH hospital mortality was 18.3%. Admission GCS, age and medical co-morbidities significantly impacted mortality following multivariate analysis (P< 0.05). Association with mortality based on GCS was 7%(14-15; score=0), 18%(9-13; score=1), 40%(5-8; score=2) and 65%(3-4; score=4). Mortality based on age was 13%(18-49; score=0), 18%(50-69; score=1), 34%(70-79; score=2) and 46%(>80; score=3). Relationship of co-morbidities and mortality was 9%(none; score=0), 17%(one; score=1) and 32%(two/more; score=2). Summated Scores ranged from 0-8 with progressively escalating mortality at higher scores (0=2%/ 1=6%/ 2=8%/ 3=13%/ 4=30%/ 5=54%/ 6=80%/ 7=89%/ 8=100%). PPV for scores in the range 7-8 was 90% while 6-8 was 84%. NPV was 94% for range 0-2 and 91% for 0-3. The area under the curve (AUC) for the SAH score was 0.822 (good accuracy), compared to WFNS scale (AUC 0.777, fair accuracy) and Hunt & Hess Grade (AUC 0.771, fair accuracy).

Conclusions The SAH score is more accurate in predicting SAH mortality compared to Hunt & Hess Grade and WFNS scale.

Authors/Disclosures
Robert G. Kowalski, MBChB, MS (Harbor Hospital) PRESENTER	The institution of Dr. Kowalski has received research support from Henry Ford Hospital. The institution of Dr. Kowalski has received research support from MaxQ. Dr. Kowalski has a non-compensated relationship as a Editor-in-Chief, newsletter with PRe-hospital Stroke Treatment Organization (PRESTO) that is relevant to AAN interests or activities.
Tiffany Chang, MD	Dr. Chang has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for National Football League.
	No disclosure on file
	No disclosure on file
Paul A. Nyquist, MD, MPH, FAAN (johns hopkins)	Dr. Nyquist has received personal compensation in the range of $500-$4,999 for serving as a Consultant for astra Zenneca. The institution of Dr. Nyquist has received research support from NIH.
David A. Grimes, MD	No disclosure on file
Juan R. Carhuapoma, MD (THe Johns Hopkins Hospital)	Dr. Carhuapoma has nothing to disclose.
	No disclosure on file
Neeraj Naval, MD (Lyerly Neurosurgery- Baptist Health)	No disclosure on file

��ɫ��

��ɫ��