Prognostication of long‐term outcomes after subarachnoid hemorrhage: The FRESH score

ObjectiveTo create a multidimensional tool to prognosticate long‐term functional, cognitive, and quality of life outcomes after spontaneous subarachnoid hemorrhage (SAH) using data up to 48 hours after admission. MethodsData were prospectively collected for 1,619 consecutive patients enrolled in the SAH outcome project July 1996 to March 2014. Linear models (LMs) were applied to identify factors associated with outcome in 1,526 patients with complete data. Twelve‐month functional, cognitive, and quality of life outcomes were measured using the modified Rankin scale (mRS), Telephone Interview for Cognitive Status, and Sickness Impact Profile. Based on the LM residuals, we constructed the FRESH score (Functional Recovery Expected after Subarachnoid Hemorrhage). Score performance, discrimination, and internal validity were tested using the area under the receiver operating characteristic curve (AUC), Nagelkerke and Cox/Snell R2, and bootstrapping. For external validation, we used a control population of SAH patients from the CONSCIOUS‐1 study (n = 413). ResultsThe FRESH score was composed of Hunt & Hess and APACHE‐II physiologic scores on admission, age, and aneurysmal rebleed within 48 hours. Separate scores to prognosticate 1‐year cognition (FRESH‐cog) and quality of life (FRESH‐quol) were developed controlling for education and premorbid disability. Poor functional outcome (mRS = 4–6) for score levels 1 through 9 respectively was present in 3, 6, 12, 38, 6...
Source: Annals of Neurology - Category: Neurology Authors: Tags: Research Article Source Type: research