Article
Evaluation of GCS-P and ECS as prognostic scores in aneurysmal subarachnoid haemorrhage
Evaluation von GCS-P und ECS als Prognosescores bei aneurysmatischer Subarachnoidalblutung
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Authors
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Marius Mader
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Andras Piffko
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Franz Lennard Ricklefs
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Lasse Dührsen
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Manfred Westphal
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Nils Ole Schmidt
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Jan Regelsberger
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Patrick Czorlich
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: A score combining Glasgow Coma Scale (GCS) and pupil response (GCS-P) as well as the Eppendorf-Köln Scale (ECS) have been introduced as novel trauma scores recently. This study aims to evaluate the prognostic value of these scores in aneurysmal subarachnoid hemorrhage (SAH).
Methods: Anonymous data of SAH patients admitted to our institution from November 2010 to July 2018 were retrospectively reviewed. Initial GCS, pupil response and motor response were collected and GCS-P and ECS calculated. Outcome measures were mortality, Glasgow Outcome Scale (GOS) at discharge and best GOS reached within 15 months follow-up. GOS was dichotomized in favorable (GOS 4&5) and unfavorable (GOS 1-3) neurological outcome. The predictive power of Hunt & Hess scale (H&H), World Federation of Neurosurgical Societies (WFNS) scale, Fisher scale, GCS, GCS-P and ECS was modeled using area under the receiver operating characteristic (AUROC) curve analyses.
Results: The study cohort consisted of 477 SAH patients with a mean (± standard deviation) age of 55.1±13.5 years and female predominance (66.0%). Median H&H was 2 (Interquartile range (IQR) 2–4), median WFNS 1 (IQR 1–5), median Fisher 4 (IQR 3–4), median GCS 15 (IQR 7–15), median GCS-P 15 (IQR 7–15) and median ECS 0 (IQR 0–2). A GCS of 3 was present in 14.9% and a GCS-P of 1 was present in 3.8% of patients. Overall mortality rate was 20.0%. A favorable neurological outcome was present in 240 (53.1%) and 207 (58.6%) patients at discharge and follow-up, respectively. Follow-up data was based on 353 patients with a mean follow-up period of 236.7 days. AUROC values for mortality prediction were 0.807 (H&H), 0.786 (WFNS), 0.625 (Fisher), 0.779 (GCS), 0.795 (GCS-P) and 0.796 (ECS). Except for Fisher scale, 95% confidence intervals were overlapping. With regards to favorable neurological outcome at discharge (and follow-up), AUROC was 0.778 (0.794) for GCS-P and 0.774 (0.771) for ECS in comparison to 0.824 (0.815) for H&H and 0.778 (0.794) for WFNS. Mortality rate for patients with a GCS of 3 was 54.3% whereas 88.9% of patients with the worst GCS-P of 1 and 85.7% with the worst ECS of 8 died.
Conclusion: Overall predictive performance of GCS-P and ECS appears comparable to established SAH scores. Included information about pupil response in the GCS-P and ECS may be useful for more detailed description and identification of most severely affected subgroups of SAH while maintaining an easy-to-use format.
