The Wessex modified Richmond Sedation Scale as a novel tool for monitoring patients at risk of malignant MCA syndrome

  • Tayyib T. A. Hayat
  • Matthew A. Myers
  • John Hell
  • Matthew Cordingly
  • Diederik O. Bulters
  • Nicolas Weir
  • George Pengas
Original Article - Vascular
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Abstract

Background

The Wessex Modified Richmond Sedation Scale (WMRSS) has been developed with the aim of improving the early identification of patients requiring decompressive hemicraniectomy for malignant middle cerebral artery syndrome (MMS). The objective of this study was to evaluate the WMRSS against the Glasgow Coma Scale (GCS).

Methods

A retrospective study was conducted of patients admitted to our unit for observation of MMS. Data were obtained on WMRSS and GCS recordings from admission up to 120-h post-ictus. Patients’ meeting inclusion criteria were recommended for theatre based on subsequent deteriorations in consciousness on either WMRSS or GCS from a 6-h post-stroke baseline, after ruling out non-neurological causes.

Results

Approximately, 60% of those eligible for monitoring were not recommended for theatre, and none died; however, these patients continued to demonstrate some variability in recorded conscious level. Patients requiring surgical intervention showed earlier drops in WMRSS compared to GCS. Neither the GCS nor the WMRSS on admission predicted the subsequent need for decompressive surgery. There was no increase in mortality with the introduction of WMRSS.

Conclusions

WMRSS adds value to monitoring MMS by indicating need for surgery prior to GCS. Early reduction in consciousness may not be sufficient for proceeding to surgical intervention, but subsequent reduction in consciousness may be a more appropriate criterion for surgery.

Keywords

Malignant MCA syndrome Glasgow coma scale Stroke 

Notes

Compliance with ethical standards

Ethical approval

Approval for the study was obtained from Southampton University Hospitals NHS Trust Clinical Effectiveness Committee (Ref: ZUAD3316) and University of Southampton Ethics and Research Governance Committee (Ref: 14786). For this type of study formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Tayyib T. A. Hayat
    • 1
  • Matthew A. Myers
    • 1
  • John Hell
    • 1
  • Matthew Cordingly
    • 1
  • Diederik O. Bulters
    • 1
  • Nicolas Weir
    • 1
  • George Pengas
    • 1
  1. 1.Wessex Neurological CentreUniversity Hospital SouthamptonSouthamptonUK

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