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Updated: Mar 8, 2026
The Rabbit Blood-shunt Model for the Study of Acute and Late Sequelae of Subarachnoid Hemorrhage: Technical Aspects
Published on: October 2, 2014
Development of the IS-Score: A Novel Predictive Model for Shunt Requirement Following Aneurysmal Subarachnoid
Lejla Islamagič1,2, Ilies Djebbara3,4, Troels Halfeld Nielsen3,5,4
1Department of Neurosurgery, Odense University Hospital, Kløvervænget 47, Entrance 44, 5000, Odense, Denmark. lejla.islamagic@rsyd.dk.
Background:
Chronic hydrocephalus after aneurysmal subarachnoid hemorrhage is a common condition that can require shunting of cerebrospinal fluid to the peritoneal cavity [ventriculoperitoneal shunting (VPS)]. Several predictive scoring systems have been developed to estimate the risk of requiring VPS, most recently the Mayo age, grade, EVD (MAGE) score and the SAH-VP score. The aim of this study was to identify predictors of ventriculoperitoneal shunt dependency and to develop a new predictive score to compare with the MAGE and SAH-VP scores.
Methods:
A retrospective single-center cohort study of 220 patients admitted with computed tomography (CT)-verified aneurysmal subarachnoid hemorrhage (aSAH), of whom 114 required extraventricular drainage, between 1 September 2018 and 21 January 2025, was conducted. They were categorized into two groups: those requiring VPS (n = 62) and those who did not (n = 52). Univariate and multivariate analyses (least absolute shrinkage and selection operator logistic regression combined with the extended Bayesian information criterion for the latter) were performed. Statistically significant variables were entered into a generalized linear model. A clinical risk score was developed by scaling and rounding the bootstrapped regression coefficients relative to the smallest significant effect.
Results:
Least absolute shrinkage and selection operator (LASSO) regression identified seven predictors: intensive care unit (ICU) stay ≥10 days (OR 10.85), World Federation of Neurological Surgeons (WFNS) score of 5 (OR 1.35), EVD duration≥14 days (OR 1.73), two or more failed weaning attempts (OR 5.38), clamp failure (OR 2.99), cerebrospinal fuid (CSF) output>200 mL in the frst 3 days (OR 3.67), and failed closure after weaning (OR 4.42). The final model, named the Islamagič Shunt score (IS-score) demonstrated a bootstrapped area under the receiver operating characteristic curve (AUC) of 0.914 (95% CI 0.87-0.95). In comparison, the SAH-VP yielded an AUC of 0.736 (95% CI 0.66-0.80) and the MAGE score an AUC of 0.791 (95% CI 0.73-0.85).
Conclusions:
The IS-score demonstrated superior predictive performance for VPS following aSAH compared with the MAGE and SAH-VP scores, but further external validation is needed.
