New Grade Scale On The Early Period After Spontaneous Subarachnoid Hemorrhage:for Prediction Delayed Cerebral Ischemia

Objective:Spontaneous subarachnoid hemorrhage(SAH)is a disastrous neurologic disease with high morbidity and mortality rates.Lots factors affect the development of nature evolution and prognosis after SAH attack which include demographic information,clinical and radiographic presentation.Past studies raised plenty of grading scales to reflect the severity of hemorrhage and to predict outcome.Such scales can be divided into clinical scale,radiographic scale and combined scale.We designed a new scale based on the multiple risk factors to evaluate the possibility of delayed cerebral ischemia(DCI)at the early period(<72h)after SAH.Methods:We retrospectively reviewed the patients with spontaneous SAH admitted to our institution from Jan 1,2014 to Dec 31,2014.Demographic information,clinical and radiographic presentation at early 72h were considered as risk factors.Our mSWAI scale was developed from a multivariable logistic regression model.Prognostic value of the mS WAI scale for the prediction of DCI was assessed by ROC curve compared with other scales.Results:433 patients with spontaneous SAH were included in our study.According to the multivariable analysis,the variables independently associated with World Federation of Neurosurgical Societies(WFNS)scale(OR=4.551,95%CI=2.433-8.511),modified Fisher Scale(mFS)(OR=4.751,95%CI=1.999-11.295),Subarachnoid Hemorrhage Early Brain Edema Score(SEBES)(OR=2.039,95%CI=1.095-3.296),intraventricular hemorrhage(OR=1.846,95%CI=1.034-3.296),aneurismal(OR=5.439,95%CI=1.729-17.110,p=0.004)。Setting of mSWAI scale was WFNS(1-3=0;4-5=2),mFS(0-2=0;3-4=2),SEBES(0-2=0;3-4=1),intraventricular hemorrhage(No=0;Yes=1),aneurysmal(No=0;Yes=2).And mS WAI scale was identified owning a prognostic value in DCI after SAH when compared with other grading systems.Besides it also showed similar predictive power in outcome.Conclusion:mSWAI scale provide a practical method at the early 72h after SAH to predict DCI happen.It would facilitate neurologist to give a obligatory DCI precautions at admission which may bring a preferable outcome.