Modified Glasgow coma scale for predicting outcome after subarachnoid hemorrhage surgery

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Aneurysmal subarachnoid hemorrhage (aSAH) outcomes are predicted by various grading scales, primarily based on neurological status.
• Existing scales may not fully capture the complexity of patient status post-aSAH.

Purpose of the Study:

• To develop and validate a novel grading scale, the GCS-F score, for predicting outcomes and vasospasm in aSAH patients.
• To compare the predictive performance of the GCS-F score against existing scales.

Main Methods:

• Retrospective analysis of 597 aSAH patients treated between 2008-2017.
• Development of the GCS-F score by combining initial Glasgow Coma Scale (GCS) and modified Fisher Scale (mFS) data.
• Receiver operating characteristic (ROC) curve analysis to compare the GCS-F score with other scales (e.g., WFNS, mFS) for predicting outcomes and vasospasm.

Main Results:

• The GCS-F score demonstrated high predictive accuracy: 90.5% AUC for unfavorable outcomes and 88.4% AUC for in-hospital mortality.
• For vasospasm prediction, the GCS-F score achieved an AUC of 0.936, outperforming the World Federation of Neurosurgical Societies (WFNS) scale (0.912) and mFS (0.704).

Conclusions:

• The GCS-F score, integrating clinical (GCS) and radiographic (mFS) information, provides a more comprehensive assessment of aSAH patients.
• The GCS-F score is a valuable tool for predicting patient outcomes and the likelihood of developing vasospasm following aSAH.