Neurological and Psychosocial Outcome after Subarachnoid Haemorrhage, and the Hunt & Hess Scale as a Predictor of Clinical Outcome

Abstract

In a retrospective study, the outcome of 87 patients with ruptured intracranial aneurysm was assessed. Follow-up included neurological examination, grading of the Glasgow Outcome Scale (GOS) of each patient, and answering a psycho-social questionnaire. This questionnaire was answered by the patients themselves or by a relative when the patient was not able to answer. The follow-up was performed more than 12 months after the occurrence of subarachnoid hemorrhage (SAH) in each patient. The psycho-social questionnaire pertained to the degree of independence in everyday activities, household management, stress endurance, memory and concentration, social and leisure activities, social contacts, occupational status, and marital relationships. By summarizing the results of these domains, the quality of life was then determined using the method described by McKenna et al. Neurological deficits in the form of an incomplete paresis of the third cranial nerve and subjective reduction of memory and concentration were identified in 3.5 % and 34.5-39 % of the patients, respectively. Of the 87 study participants, 58.2 % were fully independent, 22.4 % were able to live at home with the support of their relatives, and 5 patients were fully dependent. The occupational status of 21 patients who were fully employed before SAH was unaffected, whereas 3 patients were placed in positions with less responsibility, and 21 patients were either unable to continue working, unemployed, or retired. The quality of life was not reduced in 57.2 %, while a mild reduction in the quality of life was reported by 23.8 % and a severe reduction by 19.0 % of the participants. The ability of the initial Hunt and Hess grade, the initial Fisher grade, the extent of neurological deficits, and the occupational status after SAH to predict the patient's outcome was also evaluated. For statistical analysis, the Kendall-Tau-b-test for non-parametric correlations was applied. Significant correlations were found between the initial Hunt and Hess grade and the initial Fisher grade, between neurological deficits and GOS, between quality of life and occupational outcome, as well as between the GOS and quality of life assessment, but not between initial Hunt and Hess grade and GOS or quality of life, between neurological deficits and quality of life, between initial Hunt and Hess grade and occupational outcome, between initial Fisher grade and occupational outcome, and also not between initial Fisher grade and GOS or quality of life. Our results suggest that neither the initial Hunt & Hess grade nor the initial Fisher grade are suitable parameters for predicting the outcome of patients with ruptured intracranial aneurysms. The fact that GOS and quality of life correlated significantly confirms the use of GOS as a simple method for evaluating patient outcome, although it is not a grading system for evaluating functional disorders such as memory or subtle cognitive impairments.

Description of Quality of Life and Its Predictors in Patients with Aneurysmal Subarachnoid Hemorrhage

“…Cedzich et al [16] found correlations between the GOS and the quality of life; however, in their study they stated that neither the Hunt and Hess scale nor the Fisher scale is a predictor. In our study the Fisher scale does not predict any of the dimensions studied, but in the predictive model of the Vitality dimension the Hunt and Hess scale does intervene.…”

“…Other factors that have also been related to poorer quality of life are physical handicap as rated on the Rankin scale [4, 11], the presence of depression [10], age [12, 13], cognitive impairment [14], an incorrect initial diagnosis [15], the Glasgow Outcome Scale (GOS) [16] and sleep problems [17]. The majority of these studies only examined one specific variable, but they did not try to investigate how and to what extent each factor can contribute to the different dimensions of quality of life.…”

Recovery and Quality of Life in Patients with Ruptured Cerebral Aneurysms

“…Among the SAH‐related variables, we found that the extent of SAH (assessed in the Fisher's grade) is a predictor of QOL. According to Cedzich and Roth () neither the H‐Hs scale nor the Fisher's grade is a predictor of future QOL; however, Hütter et al. () stated the opposite.…”

Efficacy of early rehabilitation after surgical repair of acute aneurysmal subarachnoid hemorrhage: outcomes after verticalization on day 2-5 versus day 12 post-bleeding

“…Multiple studies have examined incidence of neurological deficits (motor deficiencies and physical changes) and changes in quality of life for aSAH patients after vasospasm, and this research has revealed high proportions of cases in which vasospasm contributed to the onset of such deficits (2,6,19). The deficits included irritability, depression, anxiety, decreased memory performance and reduced speed of information processing, as well as substantial reductions in quality of life.…”