Herniation World Federation of Neurosurgical Societies Scale Improves Prediction of Outcome in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage
Raabe A, Beck J, Goldberg J, Źgraggen WJ, Branca M, Marbacher S, D'Alonzo D, Fandino J, Stienen MN, Neidert MC, Burkhardt JK, Regli L, Hlavica M, Seule M, Roethlisberger M, Guzman R, Zumofen DW, Maduri R, Daniel RT, El Rahal A, Corniola MV, Bijlenga P, Schaller K, Rölz R, Scheiwe C, Shah M, Heiland DH, Schnell O, Fung C (2022)
Publication Type: Journal article
Publication year: 2022
Journal
Book Volume: 53
Pages Range: 2346-2351
Journal Issue: 7
DOI: 10.1161/STROKEAHA.121.036699
Abstract
Background: Favorable outcomes are seen in up to 50% of patients with World Federation of Neurosurgical Societies (WFNS) grade V aneurysmal subarachnoid hemorrhage. Therefore, the usefulness of the current WFNS grading system for identifying the worst scenarios for clinical studies and for making treatment decisions is limited. We previously modified the WFNS scale by requiring positive signs of brain stem dysfunction to assign grade V. This study aimed to validate the new herniation WFNS grading system in an independent prospective cohort. Methods: We conducted an international prospective multicentre study in poor-grade aneurysmal subarachnoid hemorrhage patients comparing the WFNS classification with a modified version - the herniation WFNS scale (hWFNS). Here, only patients who showed positive signs of brain stem dysfunction (posturing, anisocoric, or bilateral dilated pupils) were assigned hWFNS grade V. Outcome was assessed by modified Rankin Scale score 6 months after hemorrhage. The primary end point was the difference in specificity of the WFNS and hWFNS grading with respect to poor outcomes (modified Rankin Scale score 4-6). Results: Of the 250 patients included, 237 reached the primary end point. Comparing the WFNS and hWFNS scale after neurological resuscitation, the specificity to predict poor outcome increased from 0.19 (WFNS) to 0.93 (hWFNS) (McNemar, P<0.001) whereas the sensitivity decreased from 0.88 to 0.37 (P<0.001), and the positive predictive value from 61.9 to 88.3 (weighted generalized score statistic, P<0.001). For mortality, the specificity increased from 0.19 to 0.93 (McNemar, P<0.001), and the positive predictive value from 52.5 to 86.7 (weighted generalized score statistic, P<0.001). Conclusions: The identification of objective positive signs of brain stem dysfunction significantly improves the specificity and positive predictive value with respect to poor outcome in grade V patients. Therefore, a simple modification - presence of brain stem signs is required for grade V - should be added to the WFNS classification. Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT02304328.
Authors with CRIS profile
Involved external institutions
Inselspital, Universitätsspital Bern
Switzerland (CH)
Universitätsklinikum Freiburg
Germany (DE)
Universität Bern
Switzerland (CH)
Kantonsspital Aarau AG
Switzerland (CH)
Kantonsspital St.Gallen
Switzerland (CH)
Universitätsspital Basel
Switzerland (CH)
SUNY Downstate Medical Center
United States (USA) (US)
Swiss Medical Network
Switzerland (CH)
Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV)
Switzerland (CH)
Geneva University Hospitals / Hôpitaux universitaires de Genève (HUG)
Switzerland (CH)
Universitätsspital Zürich (USZ)
Switzerland (CH)
Switzerland (CH)
Universitätsklinikum Freiburg
Germany (DE)
Universität Bern
Switzerland (CH)
Kantonsspital Aarau AG
Switzerland (CH)
Kantonsspital St.Gallen
Switzerland (CH)
Universitätsspital Basel
Switzerland (CH)
SUNY Downstate Medical Center
United States (USA) (US)
Swiss Medical Network
Switzerland (CH)
Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV)
Switzerland (CH)
Geneva University Hospitals / Hôpitaux universitaires de Genève (HUG)
Switzerland (CH)
Universitätsspital Zürich (USZ)
Switzerland (CH)
How to cite
APA:
Raabe, A., Beck, J., Goldberg, J., Źgraggen, W.J., Branca, M., Marbacher, S.,... Fung, C. (2022). Herniation World Federation of Neurosurgical Societies Scale Improves Prediction of Outcome in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage. Stroke, 53(7), 2346-2351. https://doi.org/10.1161/STROKEAHA.121.036699
MLA:
Raabe, Andreas, et al. "Herniation World Federation of Neurosurgical Societies Scale Improves Prediction of Outcome in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage." Stroke 53.7 (2022): 2346-2351.
BibTeX: Download