Clinical Prediction Models for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review
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Clinical prediction models can enhance clinical decision-making and research. However, available prediction models in aneurysmal subarachnoid hemorrhage (aSAH) are rarely used. We evaluated the methodological validity of SAH prediction models and the relevance of the main predictors to identify potentially reliable models and to guide future attempts at model development.
We searched the EMBASE, MEDLINE, and Web of Science databases from January 1995 to June 2012 to identify studies that reported clinical prediction models for mortality and functional outcome in aSAH. Validated methods were used to minimize bias.
Eleven studies were identified; 3 developed models from datasets of phase 3 clinical trials, the others from single hospital records. The median patient sample size was 340 (interquartile range 149–733). The main predictors used were age (n = 8), Fisher grade (n = 6), World Federation of Neurological Surgeons grade (n = 5), aneurysm size (n = 5), and Hunt and Hess grade (n = 3). Age was consistently dichotomized. Potential predictors were prescreened by univariate analysis in 36 % of studies. Only one study was penalized for model optimism. Details about model development were often insufficiently described and no published studies provided external validation.
While clinical prediction models for aSAH use a few simple predictors, there are substantial methodological problems with the models and none have had external validation. This precludes the use of existing models for clinical or research purposes. We recommend further studies to develop and validate reliable clinical prediction models for aSAH.
KeywordsClinical prediction models Outcome Subarachnoid hemorrhage Systematic review
Funded by a Grant from the Canadian Institutes for Health Research.
Michael D. Cusimano receives grant support from the Canadian Institutes for Health Research. Nima Etminan receives grant support from the Physicians Services Incorporated Foundation. David Hasan receives grant funding from the National Institutes of Health and Brain Aneurysm Foundation. Peter Le Roux receives research funding from the National Institutes of Health and Integra and is a consultant for Codman, Integra, and Edge Therapeutics. R. Loch Macdonald receives grant funding from the Canadian Institutes for Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Brain Aneurysm Foundation, and Physicians Services Incorporated Foundation. He is a consultant for Actelion Pharmaceuticals, Ltd. and the Chief Scientific Officer of Edge Therapeutics, Inc. Stephan Mayer is a consultant for Actelion Pharmaceuticals, Ltd. Andrew Molyneux is a consultant for Micrus Endovascular and receives Grant support from the Medical Research Council UK and Cerecyte Coil Trial. Tom A. Schweizer receives grant support from the Heart and Stroke Foundation of Canada, the Canadian Institutes of Health Research, and the Ontario Ministry of Research and Innovation. Michael Todd receives grant support from the National Institutes of Health. James Torner receives grant support from the National Institutes of Health. Mervyn D. I. Vergouwen receives Grant support from the Netherlands Thrombosis Foundation and Netherlands Heart Foundation. George K. C. Wong receives grant support from the Hong Kong Food and Health Bureau and the Hong Kong University Grant Committee.
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