What are the grading systems for subarachnoid hemorrhage (SAH)?
Numerous systems are reported for grading the clinical condition of patients following subarachnoid hemorrhage (SAH). The literature was reviewed for articles pertaining to the grading of such patients, including publications on the Hunt and Hess Scale, Fisher Scale, Glasgow Coma Score (GCS), and World Federation of Neurological Surgeons Scale.
What is the AHA graded scale used for?
a graded scale used to predict the rate of mortality based on the clinical features seen in a patient presenting with an aneurysmal SAH grades I-III are associated with favorable outcome, these patients are candidates for early surgery/endovascular treatment
What is the nursing diagnosis for subarachnoid hemorrhage?
Nursing Diagnosis: Acute Pain related to disease-related headaches and muscle stiffness occurring with disuse, secondary to subarachnoid hemorrhage, as evidenced by verbalized pain in the shoulders, neck, and back Desired Outcome: The patient will notice a decline in pain, as indicated by a low pain score.
What is the best grading system for cerebral aneurysm?
Since 1933, when Bramwell proposed grading aneurysm patients as either apoplec- tic or paralytic, more than 40 grading systems for patients with cerebral aneurysm have been proposed (1–3). Historically, important systems include the Botterell (4), Nishioka. (5), and Cooperative Aneurysm Study sys- tems (6).
How is subarachnoid hemorrhage measured?
To diagnose a subarachnoid hemorrhage, your doctor is likely to recommend: CT scan. This imaging test can detect bleeding in your brain. Your doctor may inject a contrast dye to view your blood vessels in greater detail (CT angiogram).
How are subarachnoid hemorrhages graded?
Fisher's grading system of intracranial blood on CT in SAH patients....Table 6.Fisher gradeblood on CT (< 5 days after SAH)1no subarachnoid blood detected2diffuse or vertical layers < 1 mm thick3localised clot and/or vertical layer - > 1 mm4intracerebral or intraventricular clot with diffuse or no SAH1 more row
What is the Hunt Hess scale used for?
The Hunt and Hess scale was developed in 1968 as a clinical grading system to predict prognosis and outcome in patients with subarachnoid hemorrhage (SAH). A higher grade predicts a poor outcome and lower likelihood of survival.
Why are grading scales important for patients with subarachnoid hemorrhage?
They indeed found that their scale was useful in stratifying outcomes with significant accuracy. The SAH prognosis score was another scale proposed to better stratify these patients by taking into account several important contributors to outcome, such as age and aneurysm size.
What does the Fisher scale measure?
The Fisher scale is the initial and best known system of classifying the amount of subarachnoid hemorrhage on CT scans, and is useful in predicting the occurrence and severity of cerebral vasospasm, highest in grade 3 2.
What is the Fisher scale?
The Fisher Grading Scale was originally designed to predict risk of cerebral arterial vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH) based on radiographic distribution of subarachnoid hemorrhage. The Fisher scale is entirely radiographic and typically determined at presentation.
When do you use Hess vs hunt?
The Hunt and Hess scale is a grading system used to classify the severity of a subarachnoid hemorrhage based on the patient's clinical condition. The scale ranges from a score of 1 to 5. It is used as a predictor of prognosis/outcome with a higher grade correlating to a lower survival rate.
What is the recommendation for treating seizures in patient with subarachnoid hemorrhage?
Seizures are a well-known complication of aneurysmal subarachnoid hemorrhage (aSAH) and occur most commonly in the immediate posthemorrhagic period. Most commonly used antiepileptic drugs (AEDs) for seizure prophylaxis in aSAH include phenytoin and levetiracetam.
What is the cause of most subarachnoid hemorrhages?
A subarachnoid haemorrhage is most often caused by a burst blood vessel in the brain (a ruptured brain aneurysm). A brain aneurysm is a bulge in a blood vessel caused by a weakness in the blood vessel wall, usually at a point where the vessel branches off.
What is the Ogilvy and Carter scale?
Adapted from: Ogilvy CS, Carter BS. A proposed comprehensive grading system to predict outcome for surgical management of intracranial aneurysms. Neurosurgery 1998; 42:959....CriteriaPointsFisher scale score 0 to 20Fisher scale score 3 and 41Aneurysm size 10 mm or less0Aneurysm size greater than 10 mm16 more rows
What radiological scale predicts cerebral vasospasms after subarachnoid hemorrhage?
The Fisher scaleThe Fisher scale is the initial and best known system of classifying the amount of subarachnoid hemorrhage on CT scans, and is useful in predicting the occurrence and severity of cerebral vasospasm, highest in grade 3 2.
What is the severity score for a subarachnoid hemorrhage called?
The Glasgow Coma Scale (GCS) is ubiquitously used for assessing consciousness. Its three specialized scores are used to evaluate SAH; in each, a higher number is associated with a worse outcome.
What is a Grade 1 subarachnoid haemorrhage?
I – no blood. II – diffuse deposition of SAH without clots or layers of blood >1mm. III – localized clots and/or vertical layers of blood 1mm or > thickness.
What is a Grade 5 subarachnoid hemorrhage?
Background: Aneurysmal subarachnoid haemorrhage (SAH) WFNS grade V is commonly known to be associated with high mortality and a very poor prognosis for survivors. Therefore, maximal invasive therapy is frequently delayed until any spontaneous improvement with or without an external ventricular drainage occurs.
What is the Ogilvy and Carter scale?
Adapted from: Ogilvy CS, Carter BS. A proposed comprehensive grading system to predict outcome for surgical management of intracranial aneurysms. Neurosurgery 1998; 42:959....CriteriaPointsFisher scale score 0 to 20Fisher scale score 3 and 41Aneurysm size 10 mm or less0Aneurysm size greater than 10 mm16 more rows
How are aneurysms graded?
The O'Kelly-Marotta (OKM) grading scale for assessment of aneurysms treated by flow diversion. Each aneurysm is assigned a grade according to the initial degree of filling (A,B,C,D) and the degree of stasis (1,2,3) observed through the angiographic phases (arterial, capillary, venous).
What is the Fisher Scale?
9). The scale assigns a gradebased on the pattern of blood visualized on initial computedtomography (CT) scanning. It was validated prospectively in asmall series of patients (33). However, there are several limita-tions of this scale. It was developed when imaging technologyhad roughly one-tenth of the resolution currently available. Themeasurements used were actual measurements on printed CTscan images and had no relationship to the real clot thickness.Subarachnoid clot less than 1 mm in true thickness is uncom-mon, as is the finding of no blood on admission CT scan; there-fore, grades 1 and 2 were actually be quite uncommon.Classification of patients with thick SAH and intracerebral orintraventricular blood or those with intracerebral or intraven-tricular hemorrhage alone is unclear. In the original descriptionby Fisher et al. (9), grade 4 included patients with intracerebralor intraventricular blood and only diffuse thin SAH. However,confusion has arisen because some patients can have thick SAHand intracerebral or intraventricular hemorrhage. The scale issubjective, but the inter-rater reliability has been reported to behigh, with one series reporting a κof 0.90 (19). Finally, additionalfactors such as clot density and clearance rate, which may beequally important, are not considered in the Fisher Scale (34–36).
What is Hunt and Hess scale?
The Hunt and Hess scale was proposed in 1968 as a mod-ification to an older system originally reported by Botterelland colleagues in 1956 (Table 1; refs. 4and 7). The scale wasintended to be a gage of surgical risk and to aid neurosur-geons in deciding on the appropriate time after SAH at whichthe neurosurgeon should operate. It was based on the opin-ion of its authors, who judged that the most important clini-cal signs of SAH were: (a) the intensity of meningealinflammatory reaction, (b) the severity of neurological deficit,(c) the level of arousal, and (d) the presence of associated dis-ease. Therefore, a grading system based on the level of sever-ity (or axis) of the first three signs was created. The Hunt andHess scale has five grades incorporating all three axes, withdifferentiation between grades made by descriptive termi-nology. A modification was added for severe systemic dis-ease, which places the patient in the next most severe grade.In 1974, Hunt and Kosnik proposed a modification of theirSAH scale by adding a zero grade for unruptured aneurysmsand 1a grade for a fixed neurological deficit in the absence ofother signs of SAH (8).
What is a grading scale?
grading scale serves two primary functions. First, it is asystem for classification of data. However, a grading scale isa more sophisticated instrument than a classification system,because the term “grading” implies that some type of direc-tional axis is used as the basis for classification. In this way, agrading scale is a tool for measuring its primary axis. For mostof the grading scales included in this article, the primary axisis the clinical severity of SAH, and the grading scale attemptsto convert a qualitative impression of SAH severity into a quan-titative measurement with the purpose of estimating progno-sis early. The characteristics and requirements for an ideal SAHgrading scale have been discussed (19,24):
What is PAASH grading scale?
Another 5-category grading scale, the Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH) grading scale, has been developed based solely on the GCS. 2 The cut-off points between the categories were selected by calculating at which point 2 consecutives categories corresponded to a statistically significant different outcome at 6 months. However, the external validity of this scale has not been assessed. In our study population, we determined the relation between the categories on the PAASH and WFNS scales and actual outcome, and compared the prognostic accuracy of both scales.
What is the WFNS scale?
The World Federation of Neurological Surgeons (WFNS) Committee scale is a commonly used scale to determine the prognosis after subarachnoid hemorrhage (SAH). 1 This scale is based on the Glasgow Coma Scale (GCS), with focal deficits making up 1 additional level for patients with a GCS score of 14 or 13. The cut-off points in the WFNS scale are based on consensus, not on formal analysis. To date, the scale has not been thoroughly validated.
What is Glasgow Coma Scale?
Background and Purpose— A new Glasgow Coma Scale-based scale has been developed to predict patient outcome in subarachnoid hemorrhage by calculating cut-off points by which 2 consecutive categories corresponded to a statistically significant different outcome. We assessed the external validity of this Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH) scale and compared it to the commonly used World Federation of Neurological Surgeons scale.
How many categories are there in PAASH?
Based on their GCS on admission, patients were divided into the 5 categories of the PAASH: (1) GCS 15; (2) GCS 11 to 14; (3) GCS 8 to 10; (4) GCS 4 to 7; and (5) GCS 3. In case of aphasia, patients were classified according to clinically possible GCS scores, derived from their eye and motor scores. When different possible verbal scores would place patients in different categories, these patients were excluded.
Can a PAASH scale predict outcome?
Thus, a scale applied on admission will never give a 100% perfect prediction of outcome. Nevertheless, grading patients with SAH on admission is important for clinical and research purposes. The PAASH scale has a good internal and external validity regarding to clinical outcome. Moreover, in our study population, <2% could not be classified because of early intubation, which means that the PAASH scale can be applied in almost all patients with SAH.
Is PAASH a good discriminatory scale?
Our study shows that both the PAASH and WFNS scale have a good discriminatory ability with regard to patient prognosis. However, OR increased more gradually in the PAASH scale and areas under the curve were similar for both scales.
Is there a universally accepted scale for clinical assessment?
To date, there is no universally accepted scale to assess the clinical condition on admission. Both the Hunt and Hess scale and the WFNS scale are widely used in clinical practice and in research reports. Because the interobserver agreement for the Hunt and Hess scale is poor, 6 clinicians using this scale should be advised to use another scale. For these clinicians switching to the PAASH grading scale seems the best choice. Of course it would be better if one scale is used worldwide. Because the PAASH scale is very easy to apply, and based solely on the GCS, which has a much better interobserver agreement, we propose using this scale instead of the other scales in use today.