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The Hijdra scale has significant prognostic value for the functional outcome of Fisher grade 3 patients with subarachnoid hemorrhage

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Abstract

Purpose

Despite its high prevalence among patients with aneurysmal subarachnoid hemorrhage (aSAH) and high risk of delayed cerebral ischemia (DCI), the Fisher grade 3 category remains a poorly studied subgroup. The aim of this cohort study has been to investigate the prognostic value of the Hijdra sum scoring system for the functional outcome in patients with Fisher grade 3 aSAH, in order to improve the risk stratification within this Fisher category.

Methods

Initial CT scans of 72 prospectively enrolled patients with Fisher grade 3 aSAH were analyzed, and cisternal, ventricular, and total amount of blood were graded according to the Hijdra scale. Additionally, space-occupying subarachnoid blood clots were assessed. Outcome was evaluated after 6 months.

Results

Within the subgroup of Fisher grade 3, aSAH patients with an unfavorable outcome showed a significantly larger cisternal Hijdra sum score (HSS: 21.1 ± 5.2) than patients with a favorable outcome (HSS: 17.6 ± 5.9; p = 0.009). However, both the amount of ventricular blood (p = 0.165) and space-occupying blood clots (p = 0.206) appeared to have no prognostic relevance. After adjusting for the patient’s age, gender, tobacco use, clinical status at admission, and presence of intracerebral hemorrhage, the cisternal and total HSS remained the only independent parameters included in multivariate logistic regression models to predict functional outcome (p < 0.01).

Conclusion

The cisternal Hijdra score is fairly easy to perform and the present study indicates that it has an additional predictive value for the functional outcome within the Fisher 3 category. We suggest that the Hijdra scale is a practically useful prognostic instrument for the risk evaluation after aSAH and should be applied more often in the clinical setting.

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Funding.

Supported by grants from the Deutsche Forschungsgemeinschaft (DFG DR 323/5-1) to Dr. Dreier and Dr. Woitzik, and the Bundesministerium für Bildung und Forschung (Center for Stroke Research Berlin, 01 EO 0801 and Era-Net Neuron 01EW1212) to Dr. Dreier.

Research protocols were approved by the institutional review board and surrogate informed consent was obtained for all patients after a clinical decision had been taken to offer surgical treatment. All research was conducted in accordance with the Declaration of Helsinki.

Author information

Authors and Affiliations

  1. Department of Neuroradiology, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Julia S. Bretz, Georg Bohner MD & Michael Scheel MD

  2. Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Falk Von Dincklage MD

  3. Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Johannes Woitzik MD

  4. Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Johannes Woitzik MD, Maren K. L. Winkler MD, Sebastian Major MD & Jens P. Dreier MD Phd

  5. Departments of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Sebastian Major MD & Jens P. Dreier MD Phd

Authors
  1. Julia S. Bretz
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  2. Falk Von Dincklage MD
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Correspondence to Julia S. Bretz.

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Conflict of interest

J.S. Bretz, F. Von Dincklage, J. Woitzik, M.K.L. Winkler, S. Major, J.P. Dreier, G. Bohner, and M. Scheel state that there are no conflicts of interest. There have been no industry affiliations for this work that could have influenced its outcome.

Additional information

The authors G. Bohner and M. Scheel contributed equally to the manuscript.

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Bretz, J.S., Von Dincklage, F., Woitzik, J. et al. The Hijdra scale has significant prognostic value for the functional outcome of Fisher grade 3 patients with subarachnoid hemorrhage. Clin Neuroradiol 27, 361–369 (2017). https://doi.org/10.1007/s00062-016-0509-0

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  • DOI: https://doi.org/10.1007/s00062-016-0509-0

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