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Subarachnoid hemorrhage grading scales: a systematic review
David S Rosen1, R Loch Macdonald
1Section of Neurosurgery, Department of Surgery, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, IL 60637, USA.
Neurocritical Care
|September 15, 2005
Summary
Evaluating subarachnoid hemorrhage (SAH) grading systems reveals limitations in current scales. Reporting admission Glasgow Coma Score (GCS) and key prognostic factors is recommended for better patient outcome prediction.
Area of Science:
- Neurology
- Neurosurgery
- Clinical Assessment
Background:
- Subarachnoid hemorrhage (SAH) necessitates accurate patient grading for prognosis.
- Existing scales like Hunt and Hess, Fisher, Glasgow Coma Score (GCS), and WFNS have limitations.
Purpose of the Study:
- To review the advantages and limitations of current SAH grading scales.
- To evaluate newer grading systems and their prognostic capabilities.
- To identify recommendations for improved SAH patient assessment.
Main Methods:
- Literature review of SAH grading scales.
- Analysis of scale advantages, limitations, and prognostic factors.
- Assessment of scale variability and complexity.
Main Results:
- Current SAH grading scales have substantial deficits and limitations.
- Many scales are retrospective with unassessed variability.
- Adding prognostic factors increases complexity, potentially hindering adoption.
Conclusions:
- Further research is needed to develop robust SAH grading systems.
- Recommend reporting admission GCS and key prognostic factors (age, hypertension, CT findings, time, aneurysm details, hemorrhage presence, BP) for SAH patients.