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Retrospective application of risk scores to ruptured intracranial aneurysms: would they have predicted the risk of bleeding?

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Abstract

As the incidental diagnosis of unruptured intracranial aneurysms has been increasing, several scores were developed to predict risk of rupture and growth to guide the management choice. We retrospectively applied these scores to a multicenter series of patients with subarachnoid hemorrhage to test whether they would have predicted the risk of bleeding in the event of aneurysm discovery previous to its rupture. Demographical, clinical, and radiological information of 245 adults were retrieved from two neurovascular centers’ database. Data were pooled and PHASES, UCAS, and ELAPSS scores were retrospectively calculated for the whole population and their performances in identifying aneurysms at risk of rupture were compared. Mean PHASES, UCAS, and ELAPSS scores were 5.12 ± 3.08, 5.09 ± 2.62, and 15.88 ± 8.07, respectively. Around half (46%) of patients would have been assigned to the low- or very low-risk class (5-year rupture risk < 1%) in PHASES. Around 28% of patients would have been in a low-risk class, with a probability of 3-year rupture risk < 1% according to UCAS. Finally, ELAPSS score application showed a wider distribution among the risk classes, but a significant proportion of patients (45.5%) lie in the low- or intermediate-risk class for aneurysm growth. A high percentage of patients with ruptured aneurysms in this multicenter cohort would have been assigned to the lower risk categories for aneurysm growth and rupture with all the tested scores if they had been discovered before the rupture. Based on these observations, physicians should be careful about drawing therapeutic conclusions solely based on application of these scores.

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Acknowledgments

We would like to thank all colleagues of the neurovascular teams of Fondazione Policlinico Universitario Agostino Gemelli IRCCS of Rome (Enrico Marchese, MD, PhD; Alessandro Olivi, MD; Alessandro Pedicelli, MD; Alfredo Puca, MD) and Santo Spirito Hospital of Pescara (Annunziato Mangiola, MD) who contributed to treating these patients with ruptured intracranial aneurysms.

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Authors and Affiliations

  1. Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Carmelo Lucio Sturiale & Alessio Albanese

  2. Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Vittorio Stumpo, Luca Ricciardi, Kristy Latour & Alessio Albanese

  3. Department of Neurosurgery, Santo Spirito Hospital, Università degli Studi di Chieti-Pescara, Chieti, Italy

    Gianluca Trevisi & Paolo Barbone

  4. Department of Bioimaging, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Iacopo Valente

  5. Department of Anesthesiology and Intensive Care, Fodazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Sonia D’Arrigo

Authors
  1. Carmelo Lucio Sturiale
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  2. Vittorio Stumpo
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  3. Luca Ricciardi
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  4. Gianluca Trevisi
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  5. Iacopo Valente
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  6. Sonia D’Arrigo
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  7. Kristy Latour
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  8. Paolo Barbone
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  9. Alessio Albanese
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Contributions

Conception and design: CLS, VS, LR, AA. Data collection: CLS, VS, LR, GT, IV, KL, SD, PB. Data analysis: CLS, VS, SD, GT, IV, AA. Helping with data analysis: PB, LR, KL. Drafting: CLS, LR, VS, AA. Helping with drafting: SD, GT, PB, IV, KL. Approval of final version: CLS, VS, FT, GT, IV, SD, KL, PB, AA

Corresponding author

Correspondence to Vittorio Stumpo.

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The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was not needed for analysis of retrospective anonymous data.

Informed consent

All included patients gave their informed consent to the treatment of their personal data for scientific purposes at the time of treatment.

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Electronic supplementary material

Supplementary Table 1

PHASES risk score (DOCX 14 kb)

Supplementary Table 2

UCAS-based risk score (DOCX 14 kb)

Supplementary Table 3

ELAPSS score for aneurysm growth (DOCX 15 kb)

Supplementary Table 4

Percentages of distribution of the patients’ characteristics (tot. 245) in the risk (DOCX 18 kb)

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Sturiale, C.L., Stumpo, V., Ricciardi, L. et al. Retrospective application of risk scores to ruptured intracranial aneurysms: would they have predicted the risk of bleeding?. Neurosurg Rev 44, 1655–1663 (2021). https://doi.org/10.1007/s10143-020-01352-w

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  • DOI: https://doi.org/10.1007/s10143-020-01352-w

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