Prognosis of Patients Victim of Spontaneous Subarachnoid Hemorrhage: A Comparison between Radiologic Scales

Abstract

Objective To analyze the population and the early mortality rate (up to thirty days) of patients victim of spontaneous subarachnoid hemorrhage (SAH) according to the Hunt-Hess clinical scale and the Fisher and modified Fisher radiological scales.

Materials and Methods We analyzed 46 medical records and skull computed tomography (CT) scans of patients with spontaneous SAH admitted between February 2014 and December 2017 at Hospital Universitário Evangélico Mackenzie, in the city of Curitiba, state of Paraná, Brazil. The method of the study was exploratory-descriptive, transversal and retrospective, with a quantitative approach. We analyzed epidemiological (gender, age), clinical (life habits, pathologies, Glasgow coma scale and Hunt-Hess scale) and radiological (Fisher and modified Fisher scales) variables, and the Hunt-Hess and the Fisher scales were correlated with risk of death. The data was submitted to statistical analysis considering values of p < 0.05.

Result There was a higher prevalence of spontaneous SAH among women (69.5%), as well as among patients aged between 51 and 60 years (34.7%). Regarding the grades on the scales, there was higher prevalence of Fisher 4, Modified Fisher 4 and Hunt-Hess 2. Evolution to death was higher among women (76.4%) and patients aged between 61 and 70 years (35,2%).

Conclusion Mortality was higher among patients classified as Fisher 3, Modified Fisher 4 and Hunt-Hess ≥ 3. The Fisher scale is better than the modified Fisher scale to assess the risk of mortality.

Resumo

Objetivo Analisar o perfil epidemiológico, assim como a taxa de mortalidade precoce (até 30 dias do internamento) de pacientes vítimas de hemorragia subaracnóidea espontânea (HSAE) de acordo com a escala clínica de Hunt-Hess, e com as escalas radiológicas de Fisher e de Fisher modificada.

Materiais e Métodos Realizamos análise de 46 prontuários e exames de tomografia computadorizada (TC) de crânio de pacientes vítimas de HSAE no período de fevereiro 2014 a dezembro 2017 admitidos no Hospital Universitário Evangélico em Curitiba-PR. O método de escolha foi o exploratório-descritivo, transversal e retrospectivo, com abordagem quantitativa. Foram analisadas variáveis epidemiológicas (idade, sexo), clínicas (hábitos de vida, patologias, escala de coma de Glasgow e escala de Hunt-Hess) e radiológicas (escala de Fisher e de Fisher modificada), e as escalas de Hunt-Hess e de Fisher foram correlacionadas com o risco de óbito. Os dados foram submetidos a análise estatística considerando valores de p < 0,05.

Resultados Houve maior prevalência de HSAE entre mulheres (69,5%), assim como entre pacientes com idade entre 51 e 60 anos (34,7%). Entre as escalas, houve maior prevalência nas graduações Fisher 4, Fisher modificada 4 e Hunt-Hess 2. Os pacientes que mais evoluíram a óbito foram os do gênero feminino (76,4%), e também aqueles com idade entre 61 e 70 anos (35,2%).

Conclusão A mortalidade foi maior em pacientes classificados com Fisher 3, Fisher Modificado 4 e Hunt-Hess ≥ 3. A escala de Fisher é melhor do que a de Fisher modificada para avaliar o risco de mortalidade.

Keywords

intracranial vasospasm - subarachnoid hemorrhage - aneurysm - prognosis

Palavras-chave

vasoespasmo intracraniano - hemorragia subaracnóidea - aneurisma - prognóstico

• References

• 1 Greenberg MS. In Manual de neurocirurgia. 5th edition. Porto Alegre: Artmed; 2003: 728-773
• 2 Kloster R. [Subarachnoid hemorrhage in Vestfold county. Occurrence and prognosis]. Tidsskr Nor Laegeforen 1997; 117 (13) 1879-1882
• 3 Frontera JA, Claassen J, Schmidt JM. , et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery 2006; 59 (01) 21-27 , discussion 21–27
• 4 Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28 (01) 14-20
• 5 Zamponi OZJ. , et al. Analysis of intracranial aneurysms treated at a University Hospital in Curitiba. Arq Bras de Neurocirurgia 2012; 31 (02) 55-60
• 6 Choi JH, Park HS. The incidence and characteristics of patients with small ruptured aneurysms (<5 mm) in subarachnoid hemorrhage. J Korean Neurosurg Soc 2017; 60 (04) 424-432
• 7 Santos Neto PH. Perfil clínico-epidemiológico dos pacientes com aneurismas intracranianos rotos tratados cirurgicamente em hospital universitário. Curitiba: Faculdade Evangélica do Paraná; 2017. . Trabalho de conclusão de curso em Medicina.
• 8 Lasner TM, Weil RJ, Riina HA. , et al. Cigarette smoking-induced increase in the risk of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg 1997; 87 (03) 381-384
• 9 Johnston SC, Selvin S, Gress DR. The burden, trends, and demographics of mortality from subarachnoid hemorrhage. Neurology 1998; 50 (05) 1413-1418
• 10 de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 2007; 78 (12) 1365-1372
• 11 Stegmayr B, Eriksson M, Asplund K. Declining mortality from subarachnoid hemorrhage: changes in incidence and case fatality from 1985 through 2000. Stroke 2004; 35 (09) 2059-2063
• 12 Lantigua H, Ortega-Gutierrez S, Schmidt JM. , et al. Subarachnoid hemorrhage: who dies, and why?. Crit Care 2015; 19: 309
• 13 Claassen J, Vu A, Kreiter KT. , et al. Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage. Crit Care Med 2004; 32 (03) 832-838
• 14 Wartenberg KE, Schmidt JM, Claassen J. , et al. Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med 2006; 34 (03) 617-623 , quiz 624
• 15 Karamanakos PN, von Und Zu Fraunberg M, Bendel S. , et al. Risk factors for three phases of 12-month mortality in 1657 patients from a defined population after acute aneurysmal subarachnoid hemorrhage. World Neurosurg 2012; 78 (06) 631-639