1. Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study
- Author
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David Hasan, Blessing N.R. Jaja, Walter M. van den Bergh, Peter D. Le Roux, Karl Lothard Schaller, Julian Spears, Mervyn D.I. Vergouwen, Gordon D Murray, James C. Torner, Martin N. Stienen, Sen Yamagata, George K.C. Wong, R. Loch Macdonald, Nima Etminan, Peter J. Kirkpatrick, Michael D. Cusimano, Daniel Hänggi, Hester F. Lingsma, Erin M. Macdonald, John D. Pickard, Airton Leonardo de Oliveira Manoel, Hitoshi Fukuda, Kevin E. Thorpe, Bawarjan Schatlo, Michael M. Todd, Gustavo Saposnik, Ewout W. Steyerberg, Gabriel J.E. Rinkel, Tom A. Schweizer, Stephan A. Mayer, Muhammed Mamdani, Jose I. Suarez, Andrew J. Molyneux, S. Claiborne Johnston, Experimental Vascular Medicine, ANS - Neurovascular Disorders, Public Health, and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
- Subjects
ACCURACY ,VASOSPASM ,INTRACRANIAL ANEURYSMS ,Glasgow Outcome Scale ,Aneurysm, Ruptured ,Logistic regression ,Cohort Studies ,DOUBLE-BLIND ,0302 clinical medicine ,ACUTE PHYSIOLOGY SCORE ,Risk of mortality ,Prospective Studies ,Registries ,030212 general & internal medicine ,Non-U.S. Gov't ,10. No inequality ,Prospective cohort study ,Randomized Controlled Trials as Topic ,RISK ,Medicine(all) ,Subarachnoid Hemorrhage/etiology ,Research Support, Non-U.S. Gov't ,General Medicine ,Prognosis ,3. Good health ,Observational Studies as Topic ,Aneurysm, Ruptured/complications ,INFARCTION ,Cohort study ,medicine.medical_specialty ,CONTROLLED-TRIAL ,Research Support ,Risk Assessment ,03 medical and health sciences ,MAGNESIUM-SULFATE ,Journal Article ,medicine ,Humans ,cardiovascular diseases ,Validation Studies ,Risk Assessment/methods ,Ruptured/complications ,business.industry ,Reproducibility of Results ,Intracranial Aneurysm ,Subarachnoid Hemorrhage ,Aneurysm ,Confidence interval ,nervous system diseases ,ddc:616.8 ,Patient Outcome Assessment ,Clinical trial ,Intracranial Aneurysm/complications ,Emergency medicine ,PROGNOSTICATION ,Observational study ,business ,030217 neurology & neurosurgery - Abstract
Objective - To develop and validate a set of practical prediction tools that reliably estimate the outcome of subarachnoid haemorrhage from ruptured intracranial aneurysms (SAH).Design - Cohort study with logistic regression analysis to combine predictors and treatment modality.Setting - Subarachnoid Haemorrhage International Trialists' (SAHIT) data repository, including randomised clinical trials, prospective observational studies, and hospital registries.Participants - Researchers collaborated to pool datasets of prospective observational studies, hospital registries, and randomised clinical trials of SAH from multiple geographical regions to develop and validate clinical prediction models.Main outcome measure - Predicted risk of mortality or functional outcome at three months according to score on the Glasgow outcome scale.Results - Clinical prediction models were developed with individual patient data from 10 936 patients and validated with data from 3355 patients after development of the model. In the validation cohort, a core model including patient age, premorbid hypertension, and neurological grade on admission to predict risk of functional outcome had good discrimination, with an area under the receiver operator characteristics curve (AUC) of 0.80 (95% confidence interval 0.78 to 0.82). When the core model was extended to a "neuroimaging model," with inclusion of clot volume, aneurysm size, and location, the AUC improved to 0.81 (0.79 to 0.84). A full model that extended the neuroimaging model by including treatment modality had AUC of 0.81 (0.79 to 0.83). Discrimination was lower for a similar set of models to predict risk of mortality (AUC for full model 0.76, 0.69 to 0.82). All models showed satisfactory calibration in the validation cohort.Conclusion - The prediction models reliably estimate the outcome of patients who were managed in various settings for ruptured intracranial aneurysms that caused subarachnoid haemorrhage. The predictor items are readily derived at hospital admission. The web based SAHIT prognostic calculator (http://sahitscore.com) and the related app could be adjunctive tools to support management of patients.
- Published
- 2018
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