Age dependency and modification of the Subarachnoid Hemorrhage Early Brain Edema Score

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) system measures cerebral edema on CT and can be used to predict outcome after subarachnoid hemorrhage (SAH). The authors developed a modified SEBES (SEBES 6c) and assessed whether it could predict outcome after SAH better than the SEBES. Furthermore, they verified the age dependency of these scores.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>In this retrospective study, all patients with aneurysmal SAH in the period from January 2011 to February 2017 at a single institution were analyzed. The SEBES, which is based on the absence of visible sulci at two defined CT levels (0–4 points), and the SEBES 6c were determined from the initial CT. The SEBES 6c system includes the two levels from the original SEBES and one level located 2 cm below the vertex (0–6 points). The authors investigated whether the various SEBESs are age dependent and if they can predict delayed infarction (DI) and outcome.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Two hundred sixty-one patients met the study inclusion criteria. The SEBES was an independent predictor for DI (OR 1.6 per 1-point increase) and unfavorable outcome (OR 1.36 per 1-point increase), in accordance with findings in the first publication on SEBES. However, here the authors found that the SEBES was age dependent. In the age group younger than 60 years, the patients with high-grade SEBESs (3–4 points) had DIs and unfavorable outcomes significantly more often than the patients with low-grade scores (0–2 points). In the age groups 60–69 years and ≥ 70 years, no significant differences in DI and outcome were identified between high-grade and low-grade scores, although trends toward DI and unfavorable outcomes among the 60–69 age group were noted in patients with high-grade SEBESs.</jats:p><jats:p>Receiver operating characteristic curve analysis showed that SEBES 6c had a higher prognostic value in predicting outcome than SEBES (p &lt; 0.001). Furthermore, SEBES 6c predicted an unfavorable outcome (OR 1.31 per 1-point increase) and DI (OR 1.36 per 1-point increase) independent of vasospasms. SEBES 6c showed an age dependency similar to that of SEBES.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>SEBES 6c is more suitable for predicting outcome after SAH than SEBES. Furthermore, it predicts outcome and DI independently of vasospasm, so it can be used to differentiate between early brain injury– and vasospasm-dependent infarctions and outcome. However, SEBES and SEBES 6c are both age dependent and can be used for patients aged &lt; 60 years and may have limited suitability for patients aged 60–69 years and no suitability for patients aged ≥ 70 years.</jats:p></jats:sec>

Development of a nomogram for predicting clinical outcome in patients with angiogram‐negative subarachnoid hemorrhage

“…EBI is important as it reflects that the initial clinical presentation is the most important predictor of outcome 34 . It is reported that SEBES is associated with clinical markers of EBI, such as HH and WFNS, and is an independent predictor of DCI and poor short‐term and long‐term clinical outcomes 11,35 . Furthermore, WFNS and SEBES simply reflect the aggravated brain injury related to the severity of the initial bleed, and exerted their predictive effects in AN‐SAH assessment than the other clinical scales.…”

“… 34 It is reported that SEBES is associated with clinical markers of EBI, such as HH and WFNS, and is an independent predictor of DCI and poor short‐term and long‐term clinical outcomes. 11 , 35 Furthermore, WFNS and SEBES simply reflect the aggravated brain injury related to the severity of the initial bleed, and exerted their predictive effects in AN‐SAH assessment than the other clinical scales. In our present study, the nomograms were constructed based on symptomatic vasospasm, WFNS, SEBES, and bleeding pattern to facilitate a quantitative assessment of disability for individual patients once their clinical and imaging data were available.…”

Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) as a radiographic marker of clinically relevant intracranial hypertension and unfavorable outcome after subarachnoid hemorrhage

“…Only one previous study reported age as a predictor of EBE severity. Eibach et al [9] described higher SEBES (3–4) in patients younger than 60 years in a cohort of 261 patients.…”

“…In particular, the SEBES has previously been proven accurately to predict delayed cerebral edema in SAH patients [7,8]. Recently, Eibach et al [9] demonstrated that SEBES predicts outcome and delayed cerebral ischemia independently of vasospasm. The association between SEBES and functional outcome after SAH has also been shown in previous studies [8].…”

“…In addition, demographic and clinical characteristics impacting the severity of early brain edema (EBE) after SAH have thus far been poorly investigated. To date, an association between patient age and SEBES has been reported [9].…”