Comparison of the Claassen and Fisher CT classification scale to predict ischemia after aneurysmatic SAH?
C Woertgen1, O W Ullrich, R D Rothoerl
1Klinik und Poliklinik für Neurochirurgie, Universität Regensburg, Regensburg, Germany. chris.woertgen@klinik.uni-regensburg.de
Insights
The Fisher CT scale effectively predicts delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). A new Claassen scale offers no additional predictive value over the established Fisher scale for DCI.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Delayed cerebral ischemia (DCI) is a significant cause of death and disability following aneurysmal subarachnoid hemorrhage (SAH).
- The severity of SAH, assessed via initial computed tomography (CT) scans, predicts DCI, with the Fisher CT scale being a common tool.
- The Fisher CT scale's limitations include its inability to distinguish between intracerebral and intraventricular hemorrhage, prompting the development of new grading scales.
Purpose of the Study:
- To compare the predictive accuracy of existing clinical and CT-based scales for DCI.
- To validate a newly proposed Claassen CT scale in a distinct patient cohort.
- To determine if the Claassen scale offers superior prediction of DCI compared to the Fisher scale.
Main Methods:
- A retrospective analysis of 292 patients with aneurysmal SAH treated between 1995 and 2000.
- Data collection included clinical information, radiological findings, surgical outcomes, and Glasgow outcome scale follow-up.
- Statistical correlation was performed between SAH severity grading scales and the incidence of DCI.
Main Results:
- 28.5% of patients (83/292) developed DCI evidenced by ischemic lesions on CT scans.
- The Hunt and Hess grading, Fisher CT scale, and Claassen CT scale all showed statistically significant correlations with DCI.
- While all scales demonstrated an increasing odds ratio for DCI, the Fisher scale exhibited the most consistent increase.
Conclusions:
- The Claassen CT scale does not provide additional predictive information for DCI.
- The Claassen CT scale is not superior to the established Fisher CT scale in predicting DCI after aneurysmal SAH.
Background:
Delayed cerebral ischemia (DCI) is an important cause of morbidity and mortality after aneurysmatic subarachnoid hemorrhage (SAH). The severity of SAH, reflected by the amount of blood in the initial CCT, is a well-established predictor of DCI and infarction. The Fisher CT scale is widely used to predict DCI, but recent studies criticised the scale due to the fact that this scale does not differentiate between intracerebral blood clots and intraventricular hemorrhage. Thus Claasen et al. recently proposed a new grading scale to predict DCI. The aim of this study was to compare clinical scales with the CT findings and to verify this newly developed scale in a different population in order to predict DCI.[nl]
Patients And Methods:
We selected from our databank of patients suffering from aneurysmatic SAH 292 cases who had been treated between 1995 and 2000. The data acquisition included clinical data, radiological diagnostic data, the postoperative surgical course as well as a follow-up according to the Glasgow outcome scale.[nl]
Results:
83 out of 292 patients (28.5 %) developed ischemic lesions on the CT scans reflecting DCI. The severity of SAH according to the Hunt and Hess grading, the Fisher CT scale and the Claassen CT scale correlated statistically significant to DCI. All three scales showed an increasing odds ratio, but the most consistent increase was demonstrated by the Fisher scale.[nl]
Conclusions:
The newly proposed Claassen CT scale provides no additional information and seems not to be superior compared to the well-established Fisher scale to predict DCI.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:30Acute Coronary Syndrome III: Diagnostic Studies