Prediction of Outcomes for Ruptured Aneurysm Surgery

Stroke. 2019 Mar;50(3):595-601. doi: 10.1161/STROKEAHA.118.023771.

Abstract

Background and Purpose- Predicting long-term functional outcomes after intracranial aneurysmal rupture can be challenging. We developed and validated a scoring system-the Southwestern Aneurysm Severity Index-that would predict functional outcomes at 1 year after clipping of ruptured aneurysms. Methods- Ruptured aneurysms treated microsurgically between 2000 and 2014 were included. Outcome was defined as Glasgow Outcome Score (ranging from 1, death, to 5, good recovery) at 1 year. The Southwestern Aneurysm Severity Index is composed of multiple prospectively recorded patient demographic, clinical, radiographic, and aneurysm-specific variables. Multivariable analyses were used to construct the best predictive models for patient outcomes in a random 50% of the cohort and validated in the remaining 50%. A scoring system was created using the best model. Results- We identified 527 eligible patients. The Glasgow Outcome Score at 1 year was 4 to 5 in 375 patients (71.2%). In the multivariable logistic regression, the best predictive model for unfavorable outcome included intracerebral hemorrhage (odds ratio [OR], 2.53; 95% CI, 1.55-4.13), aneurysmal size ≥20 mm (OR, 6.07; 95% CI, 1.92-19.2), intraventricular hemorrhage (OR, 2.56; 95% CI, 1.15-5.67), age >64 (OR, 3.53; 95% CI, 1.70-7.35), location (OR, 1.82; 95% CI, 1.10-3.03), and hydrocephalus (OR, 2.39; 95% CI, 1.07-5.35). The Southwestern Aneurysm Severity Index predicts Glasgow Outcome Score at 1 year with good discrimination (area under the receiver operating characteristic curve, derivation: 0.816, 95% CI, 0.759-0.873; validation: 0.803, 95% CI, 0.746-0.861) and accurate calibration ( R2=0.939). Conclusions- The Southwestern Aneurysm Severity Index has been internally validated to predict 1 year Glasgow Outcome Scores at initial presentation, thus optimizing patient or family counseling and possibly guiding therapeutic efforts.

Keywords: intracranial aneurysm; microsurgery; patient outcome assessment; stroke; subarachnoid hemorrhage.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / mortality
  • Aneurysm, Ruptured / surgery*
  • Cerebral Ventricles
  • Cohort Studies
  • Female
  • Glasgow Outcome Scale
  • Humans
  • Hydrocephalus / complications
  • Hydrocephalus / mortality
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / mortality
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Reproducibility of Results
  • Severity of Illness Index
  • Treatment Outcome
  • Young Adult