Optimal PHASES Scoring for Risk Stratification of Surgically Treated Unruptured Aneurysms

Area of Science:

• Neurosurgery
• Neurology
• Medical Risk Stratification

Background:

• Unruptured intracranial aneurysms (UIAs) require careful management to prevent rupture.
• The PHASES (Population, Hypertension, Age, Size, Earlier subarachnoid hemorrhage, Site) score aids in stratifying UIA risks.
• Optimal cutoffs for the PHASES score in predicting surgical outcomes are not well-defined.

Purpose of the Study:

• To determine the optimal PHASES score cutoff for predicting neurologic outcomes in patients with surgically treated UIAs.
• To evaluate the association between PHASES score and poor neurologic outcomes post-surgery.

Main Methods:

• Retrospective review of 375 patients who underwent microneurosurgical treatment for UIA.
• Inclusion criteria: modified Rankin Scale (mRS) score ≤2 at admission.
• Primary outcome: 1-year mRS score; poor outcome defined as mRS >2.

Main Results:

• A PHASES score of 6 or higher (≥6) was identified as the optimal cutoff, maximizing prediction of poor neurologic outcome.
• Patients with PHASES scores ≥6 had significantly higher rates of poor neurologic outcomes at discharge and follow-up compared to those with scores <6.
• A PHASES score ≥6 remained a significant independent predictor of poor neurologic outcome at follow-up (OR, 2.75; P=0.003) after multivariable adjustment.

Conclusions:

• A PHASES score of 6 or higher is associated with significantly greater proportions of poor neurologic outcomes after surgical treatment for UIAs.
• This threshold can be valuable for risk stratification and guiding management decisions in UIA patients.
• Awareness of the PHASES score ≥6 cutoff may improve patient selection and surgical planning for UIAs.