Related Experiment Videos
Predicting long-term outcome in poor grade aneurysmal subarachnoid haemorrhage patients utilising the Glasgow Coma
Robert M Starke1, Ricardo J Komotar, Marc L Otten
1Department of Neurology and Neurosurgery, Columbia University, 710 West 168th Street, New York, NY 10032, USA.
Insights
The Glasgow Coma Scale (GCS) and its components predict outcomes in aneurysmal subarachnoid hemorrhage (aSAH). Motor function on admission and eye response during hospitalization are key indicators of long-term recovery.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Predicting outcomes for patients with aneurysmal subarachnoid hemorrhage (aSAH), especially those with poor-grade presentations, remains challenging.
- The Glasgow Coma Scale (GCS) is a standard tool for assessing consciousness, but its prognostic value at different time points in aSAH requires further investigation.
Purpose of the Study:
- To investigate the correlation between GCS scores and individual GCS components with long-term outcomes in aSAH patients.
- To determine the prognostic value of GCS assessments at various time points, from admission to hospital discharge.
Main Methods:
- Prospective recording of GCS scores for 160 aSAH patients presenting in stupor or coma, from admission daily until day 14.
- Outcomes assessed using the modified Rankin scale (mRS) at 14 days, 3 months, and 1 year post-admission.
- Correlation analysis using Spearman rank test to evaluate the relationship between GCS components and long-term outcomes.
Main Results:
- Among 104 surgically treated patients, favorable outcomes improved significantly over time: 13.5% at 14 days, 38.5% at 3 months, and 51% at 1 year.
- Admission GCS scores significantly correlated with one-year outcome (rs=0.472, p<0.0001).
- Admission motor examination (rs=0.533) and spontaneous eye opening during hospitalization (rs=0.738) were the strongest predictors of favorable one-year outcome.
Conclusions:
- The GCS and its components are valuable predictors of long-term outcome in aSAH patients.
- Long-term follow-up is crucial as recovery continues throughout the first year.
- Admission motor assessment and eye opening during hospitalization are particularly important for predicting favorable recovery after aSAH.
Abstract:
The Glasgow Coma Scale (GCS) is the most universally accepted system for grading level of consciousness. Predicting outcome is particularly difficult in poor grade aneurysmal subarachnoid haemorrhage (aSAH) patients. We hypothesised that the GCS and individual examination components would correlate with long-term outcome and have varying prognostic value depending on assessment time points. GCS scores of 160 aSAH patients presenting in stupor or coma were prospectively recorded on admission and each subsequent day until hospital day 14. Early treatment was planned for each patient unless the patient's family refused aggressive intervention or the patient died before surgery. Outcomes were assessed by the modified Rankin scale (mRS) at 14 days, 3 months, and one year. All patients who did not receive surgical treatment died within one year. Of the 104 patients who received surgical treatment, 13.5% of them had a favourable outcome at 14 days, 38.5% at 3 months, and 51% at one year (p<0.0001). Admission GCS scores significantly correlated with outcome (Spearman rank test, rs=0.472, p<0.0001). On admission, motor examination correlated best with one-year outcome (rs=0.533, p<0.0001). Each point increase in motor examination predicted a 1.8-fold increased odds of favourable long-term outcome (95% confidence interval [CI], 1.4-2.3). At discharge, eye examination (rs=0.760, p<0.0001) correlated best with one-year outcome, and a one point increase in eye examination predicted a 3.1-fold increased odds of favourable outcome (95% CI, 1.8-5.4). During hospitalisation, the best eye exam (rs=0.738, p<0.0001) and worst motor exam (rs=0.612, p<0.0001) were the most highly correlated with the one-year outcome. Long-term follow-up is necessary when evaluating recovery after aSAH, as outcomes improve significantly during the first year. The GCS and its individual components correlate well with long-term outcome. Admission motor examination and spontaneous eye opening during hospitalisation are most predictive of favourable recovery.
