Revisiting the WFNS Score: Native Computed Tomography Imaging Improves Identification of Patients With "False Poor Grade" Aneurysmal Subarachnoid Hemorrhage

Comparison of prediction for short-term and long-term outcomes in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Despite extensive research on prediction models for outcomes in aneurysmal subarachnoid hemorrhage (aSAH) patients, the distinction between models for short- and long-term outcomes remains insufficiently explored. This study aims to compare these models, identify the risk factors of poor outcomes, summarize the predictors of outcomes, and assess the performance of the prediction models for short- and long-term outcomes in aSAH patients. PubMed, Web of Science, the Cochrane Library, and Embase were searched to identify studies investigating risk factors for developed and/or validated prediction models for short-term (< 12 months) and long-term (≥ 12 months) outcomes in aSAH patients. The main outcome was neurological function, defined as poor if the Glasgow Outcome Scale (GOS) score was ≤ 3, or if the modified Rankin Scale (mRS) score was ≥ 3. Fifty-six studies reporting 61 models with 36,879 aSAH patients were included. A total of 93 predictors were examined and categorized into six domains including demographic factors, scoring systems, clinical factors, aneurysm characteristics, laboratory examinations, and imaging features. Among these, laboratory examinations were included in 57.45% (27/47) of models predicting short-term outcomes, while only 14.29% (2/14) of long-term prediction models incorporated them. An mFisher score of 3-4 [OR = 1.95, 95%CI (1.43, 2.64), P < 0.01] and the presence of multiple aneurysms [OR = 1.56, 95% CI (1.25, 1.94), P < 0.01] were identified as risk factors for poor short-term outcomes, however, this association was weakened in predicting poor long-term outcomes. All studies were found to have a high risk of bias, primarily due to inappropriate data sources and inadequate reporting of the analysis domain. This review suggested that aSAH patients with poor clinical scores and hypertension are at a higher risk of poor outcomes. The majority of the included prediction models perform well, but generally lack reporting in the analysis domain, which may hinder their clinical applicability.

Evaluation of FRESH scores in predicting outcome and quality of life after aneurysmal subarachnoid haemorrhage in a European patient cohort

BACKGROUND

Despite aneurysmal subarachnoid haemorrhage (aSAH) patients often experiencing physical and mental disabilities impacting their quality of life (QoL), routine assessment of long-term QoL data and predictive tools are limited. This study evaluates the newly developed "functional recovery expected after subarachnoid haemorrhage" (FRESH) scores with long-term outcomes and QoL in European aSAH patients.

METHODS

FRESH, FRESH-cog, and FRESH-quol scores were retrospectively obtained from aSAH patients. Patients were contacted, and the modified Rankin Scale (mRS), extended short form-36 (SF-36), and telephone interview for cognitive status (TICS) were collected and performed. The prognostic and empirical outcomes were compared.

RESULTS

Out of 374 patients, 171 patients (54.1%) completed the SF-36, and 154 patients completed the TICS. The SF-36 analysis showed that 32.7% had below-average physical component summary (PCS) scores, and 39.8% had below-average mental component summary (MCS) scores. There was no significant correlation between the FRESH score and PCS (p = 0.09736), MCS (p = 0.1796), TICS (p = 0.7484), or mRS 10-82 months (average 46 months) post bleeding (p = 0.024), respectively. There was also no significant correlation found for "FRESH-cog vs. TICS" (p = 0.0311), "FRESH-quol vs. PCS" (p = 0.0204), "FRESH-quol vs. MCS" (p = 0.1361) and "FRESH-quol vs. TICS" (p = 0.1608).

CONCLUSIONS

This study found no correlation between FRESH scores and validated QoL tools in a European population of aSAH patients. The study highlights the complexity of reliable long-term QoL prognostication in aSAH patients and emphasises the need for further prospective research to also focus on QoL as an important outcome parameter.