A model for predicting outcome following surgical clipping in patients with aneurysmal subarachnoid hemorrhage

Abstract

Background: Aneurysmal subarachnoid hemorrhage is one of the most serious neurosurgical conditions. There are a few studies in Thai population. Objective: To investigate factors related to poor outcome after cerebral aneurysms clipping and establish a risk score model to predict unfavorable outcome. Material and Method: A nested case-control study was conducted from cohort data between January 2010 to December 2016 at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center and Saraburi Hospital. One hundred and sixty-eight aneurysmal subarachnoid hemorrhage patients were enrolled in the study. Surgical outcome was assessed by Glasgow Outcome Scale (GOS). The number of the case per control was 1: 1. Factors associated with unfavorable outcome were analyzed. A risk score model was developed by backward stepwise binary logistic regression analysis, and the Receiver Operating Characteristic (ROC) curve was constructed. Results: Factors associated with poor outcome were the Modified Fisher grading scale of grade 3 or 4 (OR 17.8; 95% CI 6.8 to 46.7), the best motor response of Glasgow Coma Scale M4 or M5 (OR 8.1; 95% CI 3.2 to 20.4), and age of patients over than 60 years (OR 3.2; 95% CI 1.2 to 8.4). The final risk score model = 1 (age over than 60) +2.5 (GCS M4 or M5) +5.5 (Modified Fisher grading scale 3 or 4). The corresponding ROC for the accuracy of predicting the unfavorable outcome was 0.91; 95% CI 0.86 to 0.95 (p<0.001). Conclusion: The simple risk score model based on three independent factors (Modified Fisher grading scale of grade 3 or 4, the best motor response of GCS being M4 or M5, and the age of the patients >60 years) was created to predict unfavorable outcome. © 2017 Medical Association of Thailand. All rights reserved.