A Model for Predicting Outcome Following Surgical Clipping in Patients with Aneurysmal Subarachnoid Hemorrhage
Surachet Srikaew MD*, Apinan Kaewpradit MD*, Krittapon Kongkasem MD**, Dolrudee Songtish MD*
Affiliation : * Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand ** Neurosurgical unit, Saraburi regional hospital, Saraburi, Thailand
Background : Aneurysmal subarachnoid hemorrhage is one of the most serious neurosurgical conditions. There are a few
studies in Thai population.
Objective : To investigate factors related to poor outcome after cerebral aneurysms clipping and establish a risk score model
to predict unfavorable outcome.
Material and Method: A nested case-control study was conducted from cohort data between January 2010 to December 2016
at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center and Saraburi Hospital. One hundred and sixty-
eight aneurysmal subarachnoid hemorrhage patients were enrolled in the study. Surgical outcome was assessed by Glasgow
Outcome Scale (GOS). The number of the case per control was 1: 1. Factors associated with unfavorable outcome were
analyzed. A risk score model was developed by backward stepwise binary logistic regression analysis, and the Receiver
Operating Characteristic (ROC) curve was constructed.
Results : Factors associated with poor outcome were the Modified Fisher grading scale of grade 3 or 4 (OR 17.8; 95% CI 6.8
to 46.7), the best motor response of Glasgow Coma Scale M4 or M5 (OR 8.1; 95% CI 3.2 to 20.4), and age of patients over
than 60 years (OR 3.2; 95% CI 1.2 to 8.4). The final risk score model = 1 (age over than 60) +2.5 (GCS M4 or M5) +5.5
(Modified Fisher grading scale 3 or 4). The corresponding ROC for the accuracy of predicting the unfavorable outcome was
0.91; 95% CI 0.86 to 0.95 (p<0.001).
Conclusion : The simple risk score model based on three independent factors (Modified Fisher grading scale of grade 3 or
4, the best motor response of GCS being M4 or M5, and the age of the patients >60 years) was created to predict unfavorable
outcome.
Keywords : Cerebral aneurysm, Aneurysmal subarachnoid hemorrhage, Cerebral aneurysm clipping outcome, Outcome predictive model, Risk score model
