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Factors associated with clinical and radiological status on admission in patients with aneurysmal subarachnoid hemorrhage

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Abstract

Grading scales yield objective measure of the severity of aneurysmal subarachnoid hemorrhage and serve as to guide treatment decisions and for prognostication. The purpose of this cohort study was to determine what factors govern a patient’s disease-specific admission scores in a representative Central European cohort. The Swiss Study of Subarachnoid Hemorrhage includes anonymized data from all tertiary referral centers serving subarachnoid hemorrhage patients in Switzerland. The 2009–2014 dataset was used to evaluate the impact of patient and aneurysm characteristics on the patients’ status at admission using descriptive and multivariate regression analysis. The primary/co-primary endpoints were the GCS and the WFNS grade. The secondary endpoints were the Fisher grade, the presence of a thick cisternal or ventricular clot, the presence of a new focal neurological deficit or cranial nerve palsy, and the patient’s intubation status. In our cohort of 1787 consecutive patients, increasing patient age by 10 years and low pre-ictal functional status (mRS 3–5) were inversely correlated with “high” GCS score (GCS ≥ 13) (OR 0.91, 95% CI 0.84–0.97 and OR 0.67, 95% CI 0.31–1.46), “low” WFNS grade (grade VI–V) (OR 1.21, 95% CI 1.04–1.20 and OR 1.47, 95% CI 0.66–3.27), and high Fisher grade (grade III–IV) (OR 1.08, 95% CI 1.00–1.17 and OR 1.54, 95% CI 0.55–4.32). Other independent predictors for the patients’ clinical and radiological condition at admission were the ruptured aneurysms’ location and its size. In sum, chronological age and pre-ictal functional status, as well as the ruptured aneurysm’s location and size, determine the patients’ clinical and radiological condition at admission to the tertiary referral hospital.

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Acknowledgements

To Ethan Taub, MD, for reviewing the manuscript, to Selina Ackermann for editorial assistance, and to the members and collaborators of the Swiss SOS Study group.

Funding

This research was supported by departmental funds of the Department of Surgery, Basel University Hospital, Basel, Switzerland. The Basel Institute for Clinical Epidemiology & Biostatistics receives funding from Stiftung Institut für klinische Epidemiologie.

Author information

Author notes

  1. Daniel W. Zumofen and Michel Roethlisberger contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland

    Daniel W. Zumofen, Michel Roethlisberger, Luigi Mariani & Raphael Guzman

  2. Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland

    Daniel W. Zumofen & Kristine A. Blackham

  3. Department Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, CH-4031, Basel, Switzerland

    Rita Achermann & Heiner C. Bucher

  4. Department of Neurosurgery, University Hospital Göttingen, Robert Koch Strasse 40, 37075, Göttingen, Germany

    Schatlo Bawarjan

  5. Department of Neurosurgery, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland

    Martin N. Stienen & Nicolai Maldaner

  6. Department of Neurosurgery, Inselspital, University of Bern, Freiburgstrasse 16, CH-3010, Bern, Switzerland

    Christian Fung, Daniel Schoeni & Johannes Goldberg

  7. Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse 25, CH-5001, Aarau, Switzerland

    Donato D’Alonzo & Serge Marbacher

  8. Department of Neurosurgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, CH-9007, St.Gallen, Switzerland

    Andrea Ferrari & Martin Seule

  9. Department of Neurosurgery, Hopitaux Universitaires Genève, Rue Gabrielle-Perret-Gentil 4, CH-1205, Geneva, Switzerland

    Marco V. Corniola & Philippe Bijlenga

  10. Department of Neurosurgery, Ospedale Civico di Lugano, Via Tesserete 46, CH-6900, Lugano, Switzerland

    Daniele Valsecchi & Thomas Robert

  11. Service of Neurosurgery, Department of Clinical Neurosciences, University Hospital of Lausanne, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland

    Rodolfo Maduri

  12. Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0112, USA

    Jan-Karl Burkhardt

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  1. Daniel W. Zumofen
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on behalf of the Swiss SOS Study Group

Contributions

DZ, MR, RA, HB, LM, and RG designed the study. DZ, MR, SB, MS, CF, DD, NM, AF, MC, DS, JG, DV, TR, RB, MS, JB, and SM carried out sample collection. DZ, MR, RA, and HB performed data analysis. DZ, MR, KB, HB, LM, and RG wrote the manuscript. DZ, MR, RA, HB, KB, and RG revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Daniel W. Zumofen.

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Statement of human rights

Internal Review Board (IRB) and Ethical Committee approval were obtained for all participating centers (under the supervision of the Geneva ethical committee board no. 11-233R, NAC 11-085R). Most local Ethic Committees waived the need for obtaining written informed consent (justification: disproportionality). Written informed consent was obtained however from all participating patients for both the retrospective collection of data in 2009 and the prospective collection of data from 2010 onward if the local Ethic Committee had requested it. As of 2014 (implementation of the new Swiss Human Research Act), written informed consent was obtained from all participating patients in all participating centers. Consent to publish: No consent to publish from the participants to report individual patient data was obtained as no individual participant’s data in any form will be published.

Trial registration

This study was a retrospective analysis of a prospectively collected database and does not require clinical trial registration.

Conflict of interest

The authors declare that they have no conflict of interest.

Reporting

Our results are reported as recommended in the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement.

Availability of data and materials

The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request. Previous presentation: Preliminary results of this study were presented in form of a poster and abstract at the Joint Annual Meeting of the Swiss Society of Neurosurgery and the Swiss Society of Neuroradiology, September 2015, Lucerne, Switzerland.

Additional information

On behalf of the Swiss SOS Study Group Members and collaborators of the Swiss SOS Study Group are listed in the appendix

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Appendix: Swiss SOS Study Group

Appendix: Swiss SOS Study Group

Members or collaborators of the Swiss SOS Study Group that were not listed as authors include Javier Fandino, Daniel Colluccia, Marta Arrighi, Alice Venier, Dominique E. Kuhlen, Michael Reinert, Astrid Weyerbrock, Martin Hlavica, Jean-Yves Fournier, Andreas Raabe, Juergen Beck, David Bervini, Karl Schaller, Roy T. Daniel, Daniele Starnoni, Mahmoud Messerer, Marc Levivier, Emanuela Keller, Luca Regli, Oliver Bozinov, Sina Finkenstaedt, Luca Remonda, Christoph Stippich, Jan Gralla, Zsolt Kulcsar, Vitor Mendes-Pereira, Alessandro Cianfoni, Peter Ahlborn, Nicolas R. Smoll, Veit Rohde, Sina Tok, Fabian Baumann, Karl Kothbauer, Hassen Kerkeni, Hiroki Dan-Ura, Hans Landolt, Khaled Mostaguir, Yvan Gasche, Asita Sarrafzadeh, Gerhard Hildebrandt, Kerstin Winkler, Christoph Woernle, and Rene Bernays.

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Zumofen, D.W., Roethlisberger, M., Achermann, R. et al. Factors associated with clinical and radiological status on admission in patients with aneurysmal subarachnoid hemorrhage. Neurosurg Rev 41, 1059–1069 (2018). https://doi.org/10.1007/s10143-018-0952-2

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  • DOI: https://doi.org/10.1007/s10143-018-0952-2

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