Prediction of Outcomes for Ruptured Aneurysm Surgery

Vin Shen Ban, Tarek Y. El Ahmadieh, Salah G. Aoun, Aaron R. Plitt, Kristopher A. Lyon, Christopher Eddleman, Jeffrey Beecher, Cameron M. McDougall, Joan S Reisch, Babu G Welch, Duke Samson, Henry H Batjer, Jonathan A White

Research output: Contribution to journalArticle

Abstract

Background and Purpose- Predicting long-term functional outcomes after intracranial aneurysmal rupture can be challenging. We developed and validated a scoring system-the Southwestern Aneurysm Severity Index-that would predict functional outcomes at 1 year after clipping of ruptured aneurysms. Methods- Ruptured aneurysms treated microsurgically between 2000 and 2014 were included. Outcome was defined as Glasgow Outcome Score (ranging from 1, death, to 5, good recovery) at 1 year. The Southwestern Aneurysm Severity Index is composed of multiple prospectively recorded patient demographic, clinical, radiographic, and aneurysm-specific variables. Multivariable analyses were used to construct the best predictive models for patient outcomes in a random 50% of the cohort and validated in the remaining 50%. A scoring system was created using the best model. Results- We identified 527 eligible patients. The Glasgow Outcome Score at 1 year was 4 to 5 in 375 patients (71.2%). In the multivariable logistic regression, the best predictive model for unfavorable outcome included intracerebral hemorrhage (odds ratio [OR], 2.53; 95% CI, 1.55-4.13), aneurysmal size ≥20 mm (OR, 6.07; 95% CI, 1.92-19.2), intraventricular hemorrhage (OR, 2.56; 95% CI, 1.15-5.67), age >64 (OR, 3.53; 95% CI, 1.70-7.35), location (OR, 1.82; 95% CI, 1.10-3.03), and hydrocephalus (OR, 2.39; 95% CI, 1.07-5.35). The Southwestern Aneurysm Severity Index predicts Glasgow Outcome Score at 1 year with good discrimination (area under the receiver operating characteristic curve, derivation: 0.816, 95% CI, 0.759-0.873; validation: 0.803, 95% CI, 0.746-0.861) and accurate calibration ( R2=0.939). Conclusions- The Southwestern Aneurysm Severity Index has been internally validated to predict 1 year Glasgow Outcome Scores at initial presentation, thus optimizing patient or family counseling and possibly guiding therapeutic efforts.

Original languageEnglish (US)
Pages (from-to)595-601
Number of pages7
JournalStroke
Volume50
Issue number3
DOIs
StatePublished - Mar 1 2019

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Ruptured Aneurysm
Odds Ratio
Aneurysm
Cerebral Hemorrhage
Hydrocephalus
ROC Curve
Calibration
Counseling
Rupture
Logistic Models
Demography
Hemorrhage

Keywords

  • intracranial aneurysm
  • microsurgery
  • patient outcome assessment
  • stroke
  • subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Ban, V. S., El Ahmadieh, T. Y., Aoun, S. G., Plitt, A. R., Lyon, K. A., Eddleman, C., ... White, J. A. (2019). Prediction of Outcomes for Ruptured Aneurysm Surgery. Stroke, 50(3), 595-601. https://doi.org/10.1161/STROKEAHA.118.023771

Prediction of Outcomes for Ruptured Aneurysm Surgery. / Ban, Vin Shen; El Ahmadieh, Tarek Y.; Aoun, Salah G.; Plitt, Aaron R.; Lyon, Kristopher A.; Eddleman, Christopher; Beecher, Jeffrey; McDougall, Cameron M.; Reisch, Joan S; Welch, Babu G; Samson, Duke; Batjer, Henry H; White, Jonathan A.

In: Stroke, Vol. 50, No. 3, 01.03.2019, p. 595-601.

Research output: Contribution to journalArticle

Ban, VS, El Ahmadieh, TY, Aoun, SG, Plitt, AR, Lyon, KA, Eddleman, C, Beecher, J, McDougall, CM, Reisch, JS, Welch, BG, Samson, D, Batjer, HH & White, JA 2019, 'Prediction of Outcomes for Ruptured Aneurysm Surgery', Stroke, vol. 50, no. 3, pp. 595-601. https://doi.org/10.1161/STROKEAHA.118.023771
Ban VS, El Ahmadieh TY, Aoun SG, Plitt AR, Lyon KA, Eddleman C et al. Prediction of Outcomes for Ruptured Aneurysm Surgery. Stroke. 2019 Mar 1;50(3):595-601. https://doi.org/10.1161/STROKEAHA.118.023771
Ban, Vin Shen ; El Ahmadieh, Tarek Y. ; Aoun, Salah G. ; Plitt, Aaron R. ; Lyon, Kristopher A. ; Eddleman, Christopher ; Beecher, Jeffrey ; McDougall, Cameron M. ; Reisch, Joan S ; Welch, Babu G ; Samson, Duke ; Batjer, Henry H ; White, Jonathan A. / Prediction of Outcomes for Ruptured Aneurysm Surgery. In: Stroke. 2019 ; Vol. 50, No. 3. pp. 595-601.
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abstract = "Background and Purpose- Predicting long-term functional outcomes after intracranial aneurysmal rupture can be challenging. We developed and validated a scoring system-the Southwestern Aneurysm Severity Index-that would predict functional outcomes at 1 year after clipping of ruptured aneurysms. Methods- Ruptured aneurysms treated microsurgically between 2000 and 2014 were included. Outcome was defined as Glasgow Outcome Score (ranging from 1, death, to 5, good recovery) at 1 year. The Southwestern Aneurysm Severity Index is composed of multiple prospectively recorded patient demographic, clinical, radiographic, and aneurysm-specific variables. Multivariable analyses were used to construct the best predictive models for patient outcomes in a random 50{\%} of the cohort and validated in the remaining 50{\%}. A scoring system was created using the best model. Results- We identified 527 eligible patients. The Glasgow Outcome Score at 1 year was 4 to 5 in 375 patients (71.2{\%}). In the multivariable logistic regression, the best predictive model for unfavorable outcome included intracerebral hemorrhage (odds ratio [OR], 2.53; 95{\%} CI, 1.55-4.13), aneurysmal size ≥20 mm (OR, 6.07; 95{\%} CI, 1.92-19.2), intraventricular hemorrhage (OR, 2.56; 95{\%} CI, 1.15-5.67), age >64 (OR, 3.53; 95{\%} CI, 1.70-7.35), location (OR, 1.82; 95{\%} CI, 1.10-3.03), and hydrocephalus (OR, 2.39; 95{\%} CI, 1.07-5.35). The Southwestern Aneurysm Severity Index predicts Glasgow Outcome Score at 1 year with good discrimination (area under the receiver operating characteristic curve, derivation: 0.816, 95{\%} CI, 0.759-0.873; validation: 0.803, 95{\%} CI, 0.746-0.861) and accurate calibration ( R2=0.939). Conclusions- The Southwestern Aneurysm Severity Index has been internally validated to predict 1 year Glasgow Outcome Scores at initial presentation, thus optimizing patient or family counseling and possibly guiding therapeutic efforts.",
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AU - Ban, Vin Shen

AU - El Ahmadieh, Tarek Y.

AU - Aoun, Salah G.

AU - Plitt, Aaron R.

AU - Lyon, Kristopher A.

AU - Eddleman, Christopher

AU - Beecher, Jeffrey

AU - McDougall, Cameron M.

AU - Reisch, Joan S

AU - Welch, Babu G

AU - Samson, Duke

AU - Batjer, Henry H

AU - White, Jonathan A

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background and Purpose- Predicting long-term functional outcomes after intracranial aneurysmal rupture can be challenging. We developed and validated a scoring system-the Southwestern Aneurysm Severity Index-that would predict functional outcomes at 1 year after clipping of ruptured aneurysms. Methods- Ruptured aneurysms treated microsurgically between 2000 and 2014 were included. Outcome was defined as Glasgow Outcome Score (ranging from 1, death, to 5, good recovery) at 1 year. The Southwestern Aneurysm Severity Index is composed of multiple prospectively recorded patient demographic, clinical, radiographic, and aneurysm-specific variables. Multivariable analyses were used to construct the best predictive models for patient outcomes in a random 50% of the cohort and validated in the remaining 50%. A scoring system was created using the best model. Results- We identified 527 eligible patients. The Glasgow Outcome Score at 1 year was 4 to 5 in 375 patients (71.2%). In the multivariable logistic regression, the best predictive model for unfavorable outcome included intracerebral hemorrhage (odds ratio [OR], 2.53; 95% CI, 1.55-4.13), aneurysmal size ≥20 mm (OR, 6.07; 95% CI, 1.92-19.2), intraventricular hemorrhage (OR, 2.56; 95% CI, 1.15-5.67), age >64 (OR, 3.53; 95% CI, 1.70-7.35), location (OR, 1.82; 95% CI, 1.10-3.03), and hydrocephalus (OR, 2.39; 95% CI, 1.07-5.35). The Southwestern Aneurysm Severity Index predicts Glasgow Outcome Score at 1 year with good discrimination (area under the receiver operating characteristic curve, derivation: 0.816, 95% CI, 0.759-0.873; validation: 0.803, 95% CI, 0.746-0.861) and accurate calibration ( R2=0.939). Conclusions- The Southwestern Aneurysm Severity Index has been internally validated to predict 1 year Glasgow Outcome Scores at initial presentation, thus optimizing patient or family counseling and possibly guiding therapeutic efforts.

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KW - intracranial aneurysm

KW - microsurgery

KW - patient outcome assessment

KW - stroke

KW - subarachnoid hemorrhage

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