Beyond the Initial Ictus: Timing of WFNS Grade Assessment and Outcome Prediction in Aneurysmal Subarachnoid Hemorrhage.
World Federation of Neurosurgical Societies grading 48 hours post-occlusion best predicts outcome after subarachnoid hemorrhage
Beyond the Initial Ictus: Timing of WFNS Grade Assessment and Outcome Prediction in Aneurysmal Subarachnoid Hemorrhage.
To identify the clinical timepoint of World Federation of Neurosurgical Societies (World Federation of Neurosurgical Societies) grading that provides the highest prognostic accuracy for short- and long-term outcomes in aneurysmal subarachnoid hemorrhage (aSAH).
In this cohort study of 389 patients, World Federation of Neurosurgical Societies grades were recorded at first medical contact, hospital admission, immediately pre-occlusion, and 48 h post-occlusion.
higher World Federation of Neurosurgical Societies score at 48 hours predicts outcome accurately, 1.0 is perfect
Prognostic accuracy varied significantly between assessment timepoints.
Across all outcomes, World Federation of Neurosurgical Societies grading at 48 h post-occlusion demonstrated the highest discriminative power.
The prognostic accuracy remained superior at the 1 year follow-up (Glasgow Outcome Scale-Extended AUC 0.844, mRS AUC 0.823) and at long-term follow-up after 2 years or more (Glasgow Outcome Scale-Extended AUC 0.819, mRS AUC 0.784).
The World Federation of Neurosurgical Societies assessment at 48 h post-occlusion provides a better prediction of both short- and long-term functional outcomes after aSAH compared with earlier evaluations.
This timepoint may more accurately reflect a stabilized neurological status and could be used in addition to the World Federation of Neurosurgical Societies scale obtained at admission.