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

Objective:The mortality and morbidity of spontaneous aneurysmal subarachnoid hemorrhage is associated with the severity of the bleeding. Neurosurgeon often use original World Federation of Neurological Societies scale evaluation the severity of disease. Current data show a favorable outcome in up to 50% of patients with World Federation of Neurosurgical Societies (WFNS) Grade V subarachnoid hemorrhage (SAH) and a rather poor prediction of worst cases. Thus, the use-fulness of the current WFNS grading system for identifying the worst scenarios for clinical studies and for making treatment decisions is limited. One reason for this lack of differentiation is the use of "negative" or "silent" diagnostic signs aspart of the WFNS Grade V definition. The authors therefore reevaluated the WFNS scale by using "positive" clinical signsand the logic of the Glasgow Coma Scale as a progressive herniation score.Methods:The authors performed a retrospective analysis of 98 patients with SAH who had poor grades on the WFNS scale. Recording gender, GCS score, Signs of herniation (anisocoric pupils, bilaterally dilated pupils, no pupillary light re-flex, posturing), complications and surgical methods. Patients were graded according to the original WFNS scale and additionally according to a modified classifica-tion, the WFNS herniation (h-WFNS) scale (Grade â…£, no clinical signs of her-niation; Grade â…¤, clinical signs of herniation). The prediction of poor outcome was compared between these two grading systems.Results:Both scale have predictive value, The positive predictive values of Grade â…¤ for poor outcome were 70.7%(OR 2.41,95% CI 1.04-5.58) for WFNS Grade â…¤ and 80.0%(OR 4.48,95% CI 1.80-11.10) for h-WFNS Grade â…¤. With respect to mortality, the positive predictive values were 58.6%(OR 3.30,95% CI 1.40-7.77) for WFNS Grade â…¤ and 73.3%(OR 8.46,95% CI 3.40-21.02) for h-WFNS Grade â…¤.Conclusions:Limiting WFNS Grade â…¤ to the positive clinical signs of the Glasgow Coma Scale such as flexion, extension, and pupillary abnormalities in-stead of including "no motor response" increases the prediction of mortality and poor outcome in patients with severe SAH.