Modified Glasgow coma scale for predicting outcome after subarachnoid hemorrhage surgery

Bae, In‐Suk; Hu, Chun; Choi, Kyu-Sun; Yi, Hyeong-Joong

doi:10.1097/md.0000000000025815

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…Bae et al discovered a mean age of 55.9 ± 11.5 years, which is similar to our finding and, unlike Nguyen et al, has no significant role as a predictor of clinical outcome [20,22]. Similarly, Bae et al discovered that 40% of the patients had hypertension and 7.5% had diabetes, which is comparable to our demographic findings.…”

Section: Discussionsupporting

confidence: 90%

Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

Shrestha¹,

Rayamajhi²,

Shrestha³

et al. 2022

Cureus

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Background: Aneurysmal subarachnoid hemorrhage (SAH) has a high morbidity rate. Following SAH, a powerful systemic inflammatory response ensues contributing to delayed neurological deterioration and outcome. The aim of this study is to investigate if peripheral leukocytosis following SAH impacts clinical outcomes.Methods: This is a retrospective, observational, single tertiary center study of patients with SAH who underwent microsurgical clipping between 2017 and 2020. The study's inclusion criteria were aneurysmal SAH on baseline computerized tomography (CT), age above 18 years, and hospital admission within 72 hours of bleeding. Traumatic SAH, arteriovenous malformations, and mycotic aneurysms were all excluded. On admission, leukocyte counts were recorded. Demographic and clinical variables were compared between the two groups (TLC ≤12,000 and >12,000). The impact of peripheral leukocytes on clinical outcomes in terms of the Glasgow Outcome Score (GOS) was analyzed. Mann-Whitney U test for continuous variable and Fisher exact test or chi-square test for categorical variables were used for calculation of P-value. A P-value of 0.05 or less was considered statistically significant.Results: Among 90 patients who underwent clipping of ruptured aneurysms, 40 (44.4%) were anterior communicating artery (ACOMM) aneurysms, and 21 (23.3%) were middle cerebral artery(MCA), and 16 (17.8%) were posterior communicating artery (PCOMM). Clinically 57 patients (63.3%) had a World Federation of Neurosurgical Societies (WFNS) grade 1, 17 patients (18.9%) had a grade 2, four patients (4.4%) had a grade 3, and two patients (2.2%) had a grade 4. On radiological examination, six patients (6.7%) had fisher grade 1, 23 patients (25.6%) had grade 2, 22 patients (24.4%) had grade 3, and 39 (43.4%) had grade 4 SAH distribution. Clinical results were poor in 30 individuals (33.3 %), but good in 60 patients (66.7 %). On admission leukocytosis (>12,000) was seen among 34 (37.8%). Leukocytosis (>12,000) was associated with poor WFNS grade (>2); however, statistical significance was not seen with clinical outcome in terms of GOS.Conclusion: Poor clinical grade of patients following aneurysmal SAH is associated with peripheral leukocytosis; however, peripheral leukocytosis is not associated with poor outcomes.

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Section: Discussionsupporting

confidence: 90%

Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

Shrestha¹,

Rayamajhi²,

Shrestha³

et al. 2022

Cureus

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“…The inclusion criteria for the patients were as follows: (1) age ≥10 years old; (2) Hunt-Hess grades I-V; (3) spontaneous SAH was confirmed by imaging examination or lumbar puncture; (4) intracranial aneurysm was confirmed by DSA and the aneurysm resulted in SAH; and (5) the family of the patient signed the informed consent and cooperated with the clinical treatment and follow-up. The exclusion criteria were as follows: (1) the patient with aSAH did not undergo NSE examination; (2) previous intracranial aneurysms were treated by clipping or embolization; (3) diagnosis of intracranial aneurysm was unclear; (4) intracerebral hematoma unrelated to the offending aneurysm; (5) the patient was expected to live for less than 1 year due to severe cooccurrence of other systemic diseases; and (6) pregnant or nursing women.…”

Section: Study Population and Datamentioning

confidence: 99%

“…Identifying and quantifying the severity of brain injury to predict prognosis as early as possible are major challenges at present. Initial clinical status determined by Glasgow coma scale (GCS) and Hunt-Hess grade has been associated with prognosis [2,3]. However, an accurate and direct clinical indicator that can predict the prognosis of patients with aSAH is currently lacking.…”

Section: Introductionmentioning

confidence: 99%

Related Factors and a Threshold of the Maximum Neuron-Specific Enolase Value Affecting the Prognosis of Patients with Aneurysmal Subarachnoid Hemorrhage

Zhao

Shang

et al. 2022

Applied Bionics and Biomechanics

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Background. The prognosis of patients with subarachnoid hemorrhage is influenced by many factors. Neuron-specific enolase (NSE) is a biological marker of neurological damage. This study aimed to determine the related prognostic factors and whether or not the maximum NSE value (NSEmax) has a threshold between good and poor prognosis in aneurysmal subarachnoid hemorrhage (aSAH). Methods. A total of 259 patients admitted following aSAH were treated by appropriate methods. Initial neurological severity was evaluated by using the initial Glasgow coma scale and Hunt–Hess grades. NSE plasma concentration was measured during the patient’s stay in the neurosurgical intensive care unit, and NSEmax was selected for further study. The primary endpoint of the study was Glasgow outcome score (GOS), which was dichotomized as poor outcome (GOS 1–3) or good outcome (GOS 4–5) at discharge. Results. A poor outcome of patients with aSAH at discharge was associated with mild hypothermia treatment, Hunt–Hess grade, rehemorrhagia, neurogenic pulmonary edema, and pneumonia, which were independent risk factors affecting the prognosis of patients. The best threshold of the maximum value of NSE for poor or good prognosis was 26.255 μg/L (specificity 0.908). Conclusions. Poor neurological score, pulmonary complications, aneurysm rerupture, and mild hypothermia indicate a poor prognosis. NSEmax>26.255 μg/L is an independent predicting factor of poor neurological outcome at discharge after aSAH. This threshold value could help clinicians make the appropriate decision and prognosis.

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“… 31 Likewise, the score is also widely used by neurosurgeons for the initial assessment of patients with SAH, with higher scores indicating a lower level of consciousness impairment. 32 Studies by Zheng et al 16 and Ma et al 17 then found that the GCS score was significantly higher in the nimodipine combination therapy group of SAH patients after treatment. In the present study, we found that the GCS score of patients in the nimodipine-treated group were significantly higher than those in the control group.…”

Section: Discussionmentioning

confidence: 92%

Efficacy of nimodipine in the treatment of subarachnoid hemorrhage: a meta-analysis

et al. 2022

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Background Subarachnoid hemorrhage (SAH) is an uncommon and serious subtype of stroke, which leads to the loss of the patient's ability to produce and live for many years. Objective To investigate the clinical effect of nimodipine in the treatment of SAH. Methods Electronic databases including China National Knowledge Infrastructure (CNKI), VIP, SinoMed, China Master's Theses Full-text Database (CMFD), China Doctoral Dissertations Full-text Database (CDFD), Cochrane Library, PubMed and Embase were searched from 2010 and 2021. All randomized controlled trials evaluating the efficacy of nimodipine in the treatment of SAH were included in our meta-analysis. The patients were divided into control group and treatment group. Meta-analysis was performed with Stata16.0 software. Results A total of 10 studies were included. Compared with the control group, the treatment group had higher effective rate (OR = 3.21, 95% CI: 2.25, 4.58; p < 0.001), and lower incidence of adverse reactions (OR = 0.35, 95% CI: 0.19, 0.67; p = 0.001). Before treatment, no significant differences were identified in middle cerebral artery blood flow velocity and Glasgow coma scale (GCS) score between the two groups. However, after treatment, the middle cerebral artery blood flow velocity (SMD = −1.36, 95% CI: −2.28, −0.49; p = 0.002) and GCS score (SMD = 1.24, 95% CI: 0.58, 1.89; p < 0.001) in the treatment group were significantly better than those in the control group. Conclusions Nimodipine is effective in the treatment of SAH, lowering incidence of adverse reactions and therefore improving the prognosis of patients.

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Modified Glasgow coma scale for predicting outcome after subarachnoid hemorrhage surgery

Cited by 12 publications

References 23 publications

Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

Related Factors and a Threshold of the Maximum Neuron-Specific Enolase Value Affecting the Prognosis of Patients with Aneurysmal Subarachnoid Hemorrhage

Efficacy of nimodipine in the treatment of subarachnoid hemorrhage: a meta-analysis

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