Predicting 28-Day Mortality in Subarachnoid Hemorrhage

Completed

• Conditions: Subarachnoid Hemorrhage, Aneurysmal
• Interventions: Other: Glasgow coma scale; Other: Hunt-Hess scale; Other: World Federation of Neurological Surgeons (WFNS) scale; Other: modified Fisher scale; Other: VASOGRADE scale; Other: Ogilvy and Carter scale

• Registration Number: NCT06563219
• Lead Sponsor: Haseki Training and Research Hospital

Brief Summary

The investigators investigated the predictive ability of clinical and radiological scores, including the Glasgow coma scale (GCS), Hunt-Hess, World Federation of Neurological Surgeons (WFNS), and modified Fisher scales, as well as combined clinical scores such as the VASOGRADE and Ogilvy-Carter rating scales, for 28-day mortality in patients presenting to the emergency department (ED) with non-traumatic subarachnoid hemorrhage (SAH). Specifically, we tested the hypothesis that combined clinical scores are more reliable and superior to non-combined clinical and radiological scores in predicting 28-day mortality in non-traumatic SAH.

Detailed Description

Patients were divided into survivors and non-survivors, with surviving patients further categorized as either mobile or immobile based on the Glasgow outcome scale. Accordingly, patients who were dependent on daily support or in a coma were classified as immobile, whereas patients who had returned to normal life or were independent in their daily activities were classified as mobile. The demographic (age and sex), comorbidities (hypertension, diabetes mellitus \[DM\] and/or coronary artery disease \[CAD\]), vital signs (systolic blood pressure, heart rate, respiratory rate, and peripheral capillary oxygen saturation \[sPO2\]), and clinical assessment tools (GCS, Hunt Hess, WFNS, modified Fisher, VASOGRADE, and Ogilvy-Carter rating scales) on admission were compared between the groups to identify factors associated with 28-day mortality and neurological survival. Independent predictors of mortality were determined by multivariate logistic regression analysis of variables (demographic characteristics, clinical characteristics, and trauma scores) that differed significantly between survivors and non-survivors. An area under the curve (AUC) analysis was then conducted to identify which trauma score is the most reliable and superior predictor of mortality.

Study Timeline

• Study Start: 2020-09-01
• Primary Completion: 2023-09-01
• Status Verified: 2024-08
• Study Completion: 2024-08-01
• Study First Submitted: 2024-08-17
• Study First Submitted QC: 2024-08-17
• Last Update Submitted: 2024-08-17
• Study First Posted: 2024-08-20
• Last Update Posted: 2024-08-20

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 451

Inclusion Criteria

• patients (aged ≥ 18 years) who presented to the emergency department with non-traumatic Subarachnoid Hemorrhage between September 2020 and September 2023

Exclusion Criteria

• patients younger than 18 years
• patients with missing information
• patients with traumatic SAH
• patients with subdural or epidural hemorrhage
• patients with concurrent ischemic stroke

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Survivors	World Federation of Neurological Surgeons (WFNS) scale	Survivors were defined as patients who were still alive after 28 days of admission to the emergency department.
Non-survivors	modified Fisher scale	Non-survivors had passed away within 28 days of admission to the emergency department.
Survivors	Glasgow coma scale	Survivors were defined as patients who were still alive after 28 days of admission to the emergency department.
Survivors	VASOGRADE scale	Survivors were defined as patients who were still alive after 28 days of admission to the emergency department.
Survivors	Ogilvy and Carter scale	Survivors were defined as patients who were still alive after 28 days of admission to the emergency department.
Non-survivors	World Federation of Neurological Surgeons (WFNS) scale	Non-survivors had passed away within 28 days of admission to the emergency department.
Survivors	modified Fisher scale	Survivors were defined as patients who were still alive after 28 days of admission to the emergency department.
Non-survivors	VASOGRADE scale	Non-survivors had passed away within 28 days of admission to the emergency department.
Survivors	Hunt-Hess scale	Survivors were defined as patients who were still alive after 28 days of admission to the emergency department.
Non-survivors	Glasgow coma scale	Non-survivors had passed away within 28 days of admission to the emergency department.
Non-survivors	Ogilvy and Carter scale	Non-survivors had passed away within 28 days of admission to the emergency department.
Non-survivors	Hunt-Hess scale	Non-survivors had passed away within 28 days of admission to the emergency department.

Primary Outcome Measures

Name	Time	Method
Predictive ability of modified Fisher scale for 28-day mortality	From admission to 28 days	The investigators assessed the predictive ability of modified Fisher scale in determining 28-day mortality.
Predictive ability of Ogilvy-Carter rating scale for 28-day mortality	From admission to 28 days	The investigators assessed the predictive ability of Ogilvy-Carter rating scale in determining 28-day mortality.
Predictive ability of Glasgow coma scale for 28-day mortality	From admission to 28 days	The investigators assessed the predictive ability of Glasgow coma scale in determining 28-day mortality.
Predictive ability of World Federation of Neurological Surgeons (WFNS) scale for 28-day mortality	From admission to 28 days	The investigators assessed the predictive ability of World Federation of Neurological Surgeons (WFNS) scale in determining 28-day mortality.
Predictive ability of Hunt-Hess scale for 28-day mortality	From admission to 28 days	The investigators assessed the predictive ability of Hunt-Hess scale in determining 28-day mortality.
Predictive ability of VASOGRADE scale for 28-day mortality	From admission to 28 days	The investigators assessed the predictive ability of VASOGRADE scale in determining 28-day mortality.

Secondary Outcome Measures

Name	Time	Method
Predictive ability of modified Fisher scale for neurological survival	From admission to 28 days	The investigators assessed the predictive ability of modified Fisher scale in determining neurological survival
Predictive ability of World Federation of Neurological Surgeons (WFNS) scale for neurological survival	From admission to 28 days	The investigators assessed the predictive ability of World Federation of Neurological Surgeons (WFNS) scale in determining neurological survival
Predictive ability of Ogilvy-Carter rating scale for neurological survival	From admission to 28 days	The investigators assessed the predictive ability of Ogilvy-Carter rating scale in determining neurological survival
Predictive ability of Glasgow coma scale for neurological survival	From admission to 28 days	The investigators assessed the predictive ability of Glasgow coma scale in determining neurological survival
Predictive ability of Hunt-Hess scale for neurological survival	From admission to 28 days	The investigators assessed the predictive ability of Hunt-Hess scale in determining neurological survival
Predictive ability of VASOGRADE scale for neurological survival	From admission to 28 days	The investigators assessed the predictive ability of VASOGRADE scale in determining neurological survival

Trial Locations

Locations (1)

Haseki Training and Research Hospital; 🇹🇷 Istanbul, Fatih, Turkey