Significance Of Prognostic Evaluation For Patients Suffering From Aneurysmal Subarachnoid Hemorrhage Based On The Modified World Federation Of Neurological Societies(WFNS)scale

Objective: The modified World Fedration of Neurological Surgeons Sacle(WFNSS)for aneurysmal subarachnoid hemorrhage(a SAH) has been introduced by Prof. Sano et al.at the 15 th World Congress of Neurosurgery. This study was designed to evaluate the prognosis value of the patients with aneurysmal subarachnoid hemorrhage by comparing the old(o-WFNSS) and the modified WFNSS(m-WFNSS).Methods: 269 patients with a SAH, who experienced surgical treatments within 72 hours after onset in the Department of Neurosurgery at the Second Affiliated Hospital of Soochow University from January 2009 to January 2015, were analyzed, including their age, gender, Glasgow Coma Scale(GCS) on admission, neurological defects(hemiplegia or aphasia), surgical complications and operating methods etc. The prognosis was evaluated based on Glasgow Outcome Scale(GOS). The patients were divided into two subgroups: one with bad outcome, the other with favorable outcome. Death, severe disability and vegetative state(VS) were defined as bad outcome, while moderate disability and good recovery were defined as favorable outcome. Statistical analyses were performed by by Mann-Whitney U test and χ2 test; the prognosis correlation coefficient was analyzed by spearman test and logistic regression analyse; and the accuracy of prognostic evaluation for patients with a SAH in the two WFNSS grading systems was analyzed by Receiver Operator Characteristic Curve(ROC).Results:Significant differences of mean GOS of patients in discharger between every adjoining grades were observed using m-WFNSS(P<0.05), and the significant differences of prognostic distributions were also confirmed except for that between grade III and grade IV(P<0.05). In contrast, there was no significant difference of mean GOS between gradeII and grade III(P=0.418), and no significant differences of prognostic distributions were also revealed between grade II – grade III and grade III – grade IV using o-WFNSS..Significant negative correlation was observed based on the spearman test and logistic regression analysis using both WFNSS, and the OR value increased more evenly using the m-WFNSS than that using the o-WFNSS. ROC analysis showed a good predictive potential of prognosis for patients with a SAH in both WFNSS grading systems(P <0.0001), with the Areas Under Curve(AUC) of ROC was 0.812 in o-WFNSS and 0.807 in m-WFNSS.Conclusion: Although further validation is necessary, it is reliable and convenient for neurosurgeons to evaluate prognosis for patients with a SAH based on the modified WFNSS rather than the old WFNSS scale.