Predicting Shunt-Dependency After Aneurysmal Subarachnoid Hemorrhage: A Multicenter Validation Study.

Area of Science:

• Neurosurgery
• Neurology
• Clinical Epidemiology

Background:

• Clinical utility of risk scores for shunt dependency post-aneurysmal subarachnoid hemorrhage (aSAH) is limited by scarce validation data.
• This study aimed to validate existing post-aSAH shunt risk scores using a multicenter pooled analysis.

Purpose of the Study:

• To assess the predictive accuracy of established risk scores (CHESS, CHESS-Huckman, SDASH) for shunt dependency in aSAH patients.
• To compare the diagnostic performance of these risk scores through receiver operating characteristic (ROC) curve analysis.

Main Methods:

• Pooled analysis of consecutive aSAH cases from two German university hospitals (January 2010 - July 2023).
• Calculation of total scores for CHESS, CHESS-Huckman, and SDASH risk models.
• Comparison of diagnostic performance using ROC curve analysis and calibration metrics.

Main Results:

• 813 aSAH patients were included; 26.4% required ventriculoperitoneal shunt placement.
• CHESS-Huckman score demonstrated the highest predictive accuracy (AUC: 0.792), followed by SDASH (0.782) and CHESS (0.780).
• All scores showed good calibration; CHESS-Huckman performed best. Higher scores correlated with earlier shunting.

Conclusions:

• Existing risk scores, particularly CHESS-Huckman, are validated for predicting shunt dependency after aSAH.
• Clinical integration of these scores can improve early identification of patients requiring shunting.
• This may lead to reduced external ventricular drain weaning times, shorter hospital stays, and fewer CSF infections.