INTRODUCTION: Shunt-dependent hydrocephalus (HCP) after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequela that may lead to poor neurological outcome and predisposes to various interventions, (re)admissions, and complications, including a high rate of shunt failure and infections. We tested the feasibility of a new clinical risk score to identify subgroups of aSAH patients with increasing risk of shunting for HCP.
METHODS: A total of 1533 aSAH patients from the Eastern Finland Saccular Intracranial Aneurysm Database were used in a recursive partitioning analysis (RPA) to identify risk factors for shunt placement after aSAH. The risk model was built and internally validated in random split cohorts. External validation was conducted on 946 aSAH patients from the Southwestern Tertiary Aneurysm Registry and tested using receiver operating characteristic (ROC) curves.
RESULTS: The RPA defined 6 groups with successively increased risk: I (1%), II (8%), III (17%), IV (22%), V (42%), and VI (61%). These RPA groups (I-VI) also successively risk-stratified functional outcome at 12 months, shunt complications, and time-to-shunt rates. The AUC-ROC for the exploratory sample and internal validation sample was 0.82 and 0.78, respectively, with an external validation of 0.68.
CONCLUSION: Prediction modeling shunt dependency is feasible with clinically useful yields. External validation revealed a relatively good performance, considering the unadjusted differences between study cohorts. Current understanding of post-aSAH shunt dependency is fragmented, and standardizing the definitions and collection of data is needed. A universal risk and prediction model is only feasible through large-scale collaborative efforts involving well-characterized cohorts. The Aneurysmal Subarachnoid Hemorrhage Patients' Risk Assessment for Shunting (aSAH-PARAS) Consortium has been initiated to pool the collective insights and resources to address key questions in post-aSAH shunt dependency.
|Original language||English (US)|
|Number of pages||2|
|Publication status||Published - Aug 1 2016|
ASJC Scopus subject areas
- Clinical Neurology