Skip to main content

The accuracy of aneurysm size in predicting rebleeding after subarachnoid hemorrhage: a meta-analysis



Aneurysmal subarachnoid hemorrhage (SAH) is a severe cerebrovascular disease. Rebleeding is an independent predictor of unfavorable outcome after aneurysmal SAH. However, the accuracy of aneurysm size for predicting rebleeding after aneurysmal SAH is still unclear. Hence, we conducted this meta-analysis to evaluate the predictive accuracy of large aneurysm for rebleeding after SAH.


We performed a literature search in PubMed and Embase. Original studies about aneurysm size and rebleeding after SAH were included. Two reviewers completed data extraction and quality assessment. Pooled sensitivity, specificity, and their 95% confidence intervals (CIs) of large aneurysm for predicting rebleeding were calculated and shown in a forest plot. The overall accuracy of large aneurysm for predicting rebleeding after SAH was shown using a summary receiver operating characteristic (SROC) curve. Publication bias were assessed using Deeks’ funnel plot.


A total of ten studies with 3889 patients met eligibility criteria and were included in this meta-analysis. The pooled sensitivity and specificity of large aneurysm for predicting rebleeding were 0.39 (95% CI 0.25–0.56) and 0.75 (95% CI 0.67–0.82), respectively. The area under SROC curve was 0.67 (95% CI 0.62–0.71). Deeks’ funnel plot did not show obvious publication bias among included studies in this meta-analysis.


The specificity of large aneurysm for predicting rebleeding after SAH is relatively high. However, its overall accuracy for predicting aneurysm rebleeding is not very satisfying. A comprehensive model should be developed to improve the accuracy of rebleeding prediction after SAH.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Lawton MT, Vates GE (2017) Subarachnoid hemorrhage. N Engl J Med 377(3):257–266.

    Article  PubMed  Google Scholar 

  2. Rincon F, Rossenwasser RH, Dumont A (2013) The epidemiology of admissions of nontraumatic subarachnoid hemorrhage in the United States. Neurosurgery 73(2):217–222; discussion 212-213.

    Article  PubMed  Google Scholar 

  3. Taufique Z, May T, Meyers E, Falo C, Mayer SA, Agarwal S, Park S, Connolly ES, Claassen J, Schmidt JM (2016) Predictors of poor quality of life 1 year after subarachnoid hemorrhage. Neurosurgery 78(2):256–264.

    Article  PubMed  Google Scholar 

  4. Larsen CC, Astrup J (2013) Rebleeding after aneurysmal subarachnoid hemorrhage: a literature review. World Neurosurg 79(2):307–312.

    Article  PubMed  Google Scholar 

  5. Galea JP, Dulhanty L, Patel HC (2017) Predictors of outcome in aneurysmal subarachnoid hemorrhage patients: observations from a multicenter data set. Stroke 48(11):2958–2963.

    Article  PubMed  Google Scholar 

  6. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43(6):1711–1737.

    Article  PubMed  Google Scholar 

  7. Machiel Pleizier C, Algra A, Velthuis BK, Rinkel GJ (2006) Relation between size of aneurysms and risk of rebleeding in patients with subarachnoid haemorrhage. Acta Neurochir 148(12):1277–1279; discussion 1279-1280.

    CAS  Article  PubMed  Google Scholar 

  8. Inagawa T (2010) Size of ruptured intracranial saccular aneurysms in patients in Izumo City, Japan. World Neurosurg 73(2):84–92; discussion e11.

    Article  PubMed  Google Scholar 

  9. Shiue I, Arima H, Hankey GJ, Anderson CS (2011) Location and size of ruptured intracranial aneurysm and serious clinical outcomes early after subarachnoid hemorrhage: a population-based study in Australasia. Cerebrovasc Dis 31(6):573–579.

    Article  PubMed  Google Scholar 

  10. Boogaarts HD, van Lieshout JH, van Amerongen MJ, de Vries J, Verbeek AL, Grotenhuis JA, Westert GP, Bartels RH (2015) Aneurysm diameter as a risk factor for pretreatment rebleeding: a meta-analysis. J Neurosurg 122(4):921–928.

    Article  PubMed  Google Scholar 

  11. Kassell NF, Torner JC (1983) Size of intracranial aneurysms. Neurosurgery 12(3):291–297

    CAS  Article  PubMed  Google Scholar 

  12. Pare L, Delfino R, Leblanc R (1992) The relationship of ventricular drainage to aneurysmal rebleeding. J Neurosurg 76(3):422–427.

    CAS  Article  PubMed  Google Scholar 

  13. Cha KC, Kim JH, Kang HI, Moon BG, Lee SJ, Kim JS (2010) Aneurysmal rebleeding : factors associated with clinical outcome in the rebleeding patients. J Korean Neurosurg Soc 47(2):119–123.

    Article  PubMed  Google Scholar 

  14. Guo LM, Zhou HY, Xu JW, Wang Y, Qiu YM, Jiang JY (2011) Risk factors related to aneurysmal rebleeding. World Neurosurg 76(3–4):292–298; discussion 253-294.

    Article  PubMed  Google Scholar 

  15. Wu TC, Tsui YK, Chen TY, Lin CJ, Wu TC, Tzeng WS (2012) Rebleeding of aneurysmal subarachnoid hemorrhage in computed tomography angiography: risk factor, rebleeding pattern, and outcome analysis. J Comput Assist Tomogr 36(1):103–108.

    Article  Google Scholar 

  16. van Donkelaar CE, Bakker NA, Veeger NJ, Uyttenboogaart M, Metzemaekers JD, Luijckx GJ, Groen RJ, van Dijk JM (2015) Predictive factors for rebleeding after aneurysmal subarachnoid hemorrhage: rebleeding aneurysmal subarachnoid hemorrhage study. Stroke 46(8):2100–2106.

    Article  Google Scholar 

  17. Zhao B, Fan Y, Xiong Y, Yin R, Zheng K, Li Z, Tan X, Yang H, Zhong M (2016) Aneurysm rebleeding after poor-grade aneurysmal subarachnoid hemorrhage: predictors and impact on clinical outcomes. J Neurol Sci 371:62–66.

    Article  Google Scholar 

  18. Macdonald RL, Schweizer TA (2017) Spontaneous subarachnoid haemorrhage. Lancet 389(10069):655–666.

    Article  Google Scholar 

  19. Lord AS, Fernandez L, Schmidt JM, Mayer SA, Claassen J, Lee K, Connolly ES, Badjatia N (2012) Effect of rebleeding on the course and incidence of vasospasm after subarachnoid hemorrhage. Neurology 78(1):31–37.

    CAS  Article  PubMed  Google Scholar 

  20. Vergouwen MD, Jong-Tjien-Fa AV, Algra A, Rinkel GJ (2016) Time trends in causes of death after aneurysmal subarachnoid hemorrhage: a hospital-based study. Neurology 86(1):59–63.

    CAS  Article  PubMed  Google Scholar 

  21. Inagawa T, Kamiya K, Ogasawara H, Yano T (1987) Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 28(2):93–99

    CAS  Article  PubMed  Google Scholar 

  22. Ohkuma H, Tsurutani H, Suzuki S (2001) Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management. Stroke 32(5):1176–1180

    CAS  Article  PubMed  Google Scholar 

  23. Wong GK, Boet R, Ng SC, Chan M, Gin T, Zee B, Poon WS (2012) Ultra-early (within 24 hours) aneurysm treatment after subarachnoid hemorrhage. World Neurosurg 77(2):311–315.

    Article  PubMed  Google Scholar 

  24. Laidlaw JD, Siu KH (2002) Ultra-early surgery for aneurysmal subarachnoid hemorrhage: outcomes for a consecutive series of 391 patients not selected by grade or age. J Neurosurg 97(2):250–258; discussion 247-259.

    Article  PubMed  Google Scholar 

  25. Grasso G, Alafaci C, Macdonald RL (2017) Management of aneurysmal subarachnoid hemorrhage: state of the art and future perspectives. Surg Neurol Int 8:11.

    Article  PubMed  Google Scholar 

  26. Tang C, Zhang TS, Zhou LF (2014) Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis. PLoS One 9(6):e99536.

    CAS  Article  PubMed  Google Scholar 

  27. Cagnazzo F, Gambacciani C, Morganti R, Perrini P (2017) Aneurysm rebleeding after placement of external ventricular drainage: a systematic review and meta-analysis. Acta Neurochir 159(4):695–704.

    Article  PubMed  Google Scholar 

  28. Foreman PM, Starke RM, Hendrix P, Harrigan MR, Fisher WSR, Vyas NA, Lipsky RH, Lin M, Walters BC, Pittet JF, Mathru M, Griessenauer CJ (2017) Endothelin polymorphisms as a risk factor for cerebral aneurysm rebleeding following aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg 157:65–69.

    Article  PubMed  Google Scholar 

  29. Lin QS, Ping C, Lin YX, Lin ZY, Yu LH, Dai LS, Kang DZ (2016) Systolic blood pressure variability is a novel risk factor for rebleeding in acute subarachnoid hemorrhage: a case-control study. Medicine 95(11):e3028.

    Article  PubMed  Google Scholar 

  30. Beck J, Raabe A, Szelenyi A, Berkefeld J, Gerlach R, Setzer M, Seifert V (2006) Sentinel headache and the risk of rebleeding after aneurysmal subarachnoid hemorrhage. Stroke 37(11):2733–2737.

    Article  PubMed  Google Scholar 

Download references


This work was supported by National Key R&D Program of China (grant number 2018YFA 0108604), National Natural Science Foundation of China (grant number 81801186), and Outstanding Subject Development 135 Project of West China Hospital, Sichuan University (grant number ZY2016102).

Author information

Authors and Affiliations


Corresponding authors

Correspondence to Lu Ma or Chao You.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yu, Z., Zheng, J., Guo, R. et al. The accuracy of aneurysm size in predicting rebleeding after subarachnoid hemorrhage: a meta-analysis. Neurol Sci 41, 1843–1850 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Aneurysm size
  • Rebleeding
  • Subarachnoid hemorrhage