Improving prediction of outcome in "good grade" subarachnoid hemorrhage.
Neurosurgery
; 61(3): 470-3; discussion 473-4, 2007 Sep.
Article
en En
| MEDLINE
| ID: mdl-17881957
ABSTRACT
OBJECTIVE:
We hypothesize that subtle neurological signs at baseline could be present in some "good grade" subarachnoid hemorrhage (SAH) patients and that they would have negative prognostic implications.METHODS:
We analyzed data from 1000 patients randomized to the Intraoperative Hypothermia for Aneurysm Surgery Trial (World Federation of Neurological Societies Grades I, II, and III). Nine hundred and forty-four patients had a complete National Institutes of Health Stroke Scale (NIHSS) examination performed at baseline. We analyzed the relationship between baseline NIHSS scores and Glasgow Outcome Scale scores at 3 months. Using stepwise logistic regression, we identified the individual NIHSS items that independently predicted outcome to construct a useful shorter version of the scale for SAH.RESULTS:
The NIHSS was abnormal at baseline in 23% of the Grade I patients and 82% of the Grade II patients. Baseline NIHSS scores strongly predicted 3-month outcomes (P < 0.001). The NIHSS items that were relevant to predict outcome were level of consciousness, dysarthria, visual fields, and worst motor score for the arms. Baseline NIHSS-SAH scores also independently predicted 3-month outcomes (P < 0.001).CONCLUSION:
Subtle neurological signs at baseline are common in World Federation of Neurological Societies Grades I and II patients and are associated with a worse outcome at 3 months. These signs are not detected by the World Federation of Neurological Societies classification. A better stratification of "good grade" SAH patients to predict long-term outcomes may be desirable for clinical trials and practice. Either using the full NIHSS or a shortened version testing level of consciousness, visual fields, dysarthria and worst arm motor score will help to better stratify "good-grade" SAH patients.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Hemorragia Subaracnoidea
Tipo de estudio:
Clinical_trials
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Neurosurgery
Año:
2007
Tipo del documento:
Article
País de afiliación:
Estados Unidos