Abstract Details

Title Validation of the original FRESH score in patients with subarachnoid hemorrhage

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-039

Objective To externally validate the disability part of the FRESH-score, a tool to prognosticate long-term outcomes after non-traumatic subarachnoid hemorrhage (SAH), using the original score variables.

Background FRESH is a clinical tool to prognosticate long term outcomes after SAH. The score includes four variables: Hunt&Hess score, APACHE-II-physiologic score, patient age, and aneurysmal rebleed within 48 hours. Prior external validation was achieved via a surrogate score that included the World Federation of Neurosurgical Societies (WFNS) instead of the Hunt&Hess score. The original score has not been externally validated yet.

Design/Methods 139 patients with SAH were prospectively enrolled in the Yale Acute Brain Injury Biorepository between 09/2014 and 06/2018. 3-month functional outcome was recorded prospectively by trained study investigators using the modified Rankin Scale (mRS). FRESH-scores were calculated retrospectively using the original score variables. We used Rsquare statistics to assess the mRS-variance explained by the score, and the area under the receiver operating characteristic curve (AUC) to assess ability of the score to discriminate between favorable and poor (defined as mRS 4-6) outcome.

Results We identified 94 patients with SAH with complete data. Mean age was 58 years, 57% were women. In 70% an aneurysmal bleeding source was found. 79% underwent aneurysm coiling, 9% clipping, in 12% no aneurysm treatment was performed. At 3 months mortality was 13.8%, 22% had poor outcome. Discrimination of the FRESH score between favorable and poor outcome was high (AUC 88.5%, Confidence Interval 77.8-99.2%). Nagelkerke’s (0.56) and Cox&Snell’s R² (0.37) indicated satisfactory explained variance. Score performance statistics improved further in an analysis including only patients with aneurysmal SAH (n=66, AUC 92.4, CI 83.8-100.0, Nagelkerke’s R²0.67, Cox&Snell’s R²0.46).

Conclusions FRESH, a prognostication score of long-term outcomes in patients with SAH, was externally tested using the original score parameters. Statistical analysis indicated excellent score performance.

Authors/Disclosures
Jens Witsch, MD (University of Pennsylvania) PRESENTER	Dr. Witsch has a non-compensated relationship as a editorial team member with Neurology Reisdent & Fellow section that is relevant to AAN interests or activities.
Lindsey R. Kuohn, MD	Dr. Kuohn has nothing to disclose.
Charles Matouk	Charles Matouk has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Silk Road Medical. Charles Matouk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Charles Matouk has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Navigantis.
Ryan Hebert	Ryan Hebert has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus .
	No disclosure on file
Lauren H. Sansing, MD	Dr. Sansing has nothing to disclose.
Guido J. Falcone, MD (Yale School of Medicine)	The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.

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