Utility of the Hijdra Sum Score in Predicting Risk of Aneurysm in Patients With Subarachnoid Hemorrhage: A Single-Center Experience With 550 Patients

Neurosurgery. 2020 Jun 1;86(6):783-791. doi: 10.1093/neuros/nyz346.


Background: Subarachnoid hemorrhage (SAH) is most commonly caused by a ruptured vascular lesion. A significant number of patients presenting with SAH have no identifiable cause despite extensive cerebrovascular imaging at presentation. Significant neurological morbidity or mortality can result from misdiagnosis of aneurysm.

Objective: To generate a model to assist in predicting the risk of aneurysm in this patient population.

Methods: We conducted a retrospective study of all patients aged ≥18 yr admitted to a single center from March 2008 to March 2018 with nontraumatic SAH (n = 550). Patient information was compared between those with and without aneurysm to identify potential predictors. Odds ratios obtained from a logistic regression model were converted into scores which were summed and tested for predictive ability.

Results: Female sex, higher modified Fisher or Hijdra score, nonperimesencephalic location, presence of intracerebral hemorrhage, World Federation of Neurosurgical Societies (WFNS) score ≥3, need for cerebrospinal fluid diversion on admission, and history of tobacco use were all entered into multivariable analysis. Greater modified Fisher, greater Hijdra score, WFNS ≥3, and hydrocephalus present on admission were significantly associated with the presence of an aneurysm. A model based on the Hijdra score and SAH location was generated and validated.

Conclusion: We show for the first time that the Hijdra score, in addition to other factors, may assist in identifying patients at risk for aneurysm on cerebrovascular imaging. A simple scoring tool based on patient sex, SAH location, and SAH burden can assist in predicting the presence of an aneurysm in patients with nontraumatic SAH.

Keywords: Angiogram negative subarachnoid hemorrhage; Perimesencephalic; Subarachnoid hemorrhage.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Cerebral Hemorrhage / complications
  • Cerebral Hemorrhage / diagnostic imaging*
  • Cohort Studies
  • Female
  • Humans
  • Hydrocephalus / complications
  • Hydrocephalus / diagnostic imaging
  • Intracranial Aneurysm / diagnostic imaging*
  • Intracranial Aneurysm / etiology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Retrospective Studies
  • Severity of Illness Index*
  • Subarachnoid Hemorrhage / complications
  • Subarachnoid Hemorrhage / diagnostic imaging*