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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Funding

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).

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Correspondence to Lu Ma or Chao You.

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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). https://doi.org/10.1007/s10072-020-04297-6

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  • DOI: https://doi.org/10.1007/s10072-020-04297-6

Keywords

  • Aneurysm size
  • Rebleeding
  • Subarachnoid hemorrhage