Predicting outcomes in aneurysmal subarachnoid haemorrhage

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k102 (Published 24 January 2018) Cite this as: BMJ 2018;360:k102
  1. Siddharth Nath1,
  2. Alex Koziarz, MSc candidate1,
  3. Jetan H Badhiwala, neurosurgical resident2,
  4. Saleh A Almenawer, neurosurgeon1
  1. 1Division of Neurosurgery, Hamilton Health Sciences and McMaster University, Hamilton, ON, L8S 4L8, Canada
  2. 2Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to: S A Almenawer almenawers{at}gmail.com

A new model offers a clinically useful tool

Subarachnoid haemorrhage from a ruptured intracranial aneurysm (SAH) carries a high societal burden of disease, with a mortality of approximately 30%.1 It often affects otherwise healthy people, and, unlike ischaemic stroke, is skewed towards a younger patient population, with a median age of 55 years.12 Patient outcomes in SAH remain difficult to predict, with the clinical course of disease differing substantially as a result of initial clinical status, aneurysm size, and underlying comorbidities, among other factors.3

Presently, patients are classified using two well validated scales: the Hunt and Hess scale and the World Federation of Neurosurgical Societies (WFNS) classification system.45 The Hunt and Hess scale assesses the likelihood of survival based on presenting symptoms, whereas the WFNS system uses the Glasgow coma scale and the presence of focal neurological deficits to determine severity.456 A third tool, the Fisher scale, can be …

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