Background

The universal application of ultra-early surgery for World Federation of Neurological Societies (WFNS) grade V aneurysmal subarachnoid hemorrhage (aSAH) patients may lead to the increased implementation of unnecessary treatment. Therefore, this study aimed to refine the patient selection process for timely definitive treatment.

Methods

From January 2011 to March 2020, a total of 517 aSAH patients were treated at our institution. Among these, 177 aSAH patients with WFNS grade V on admission were identified from our database. Patients with improved grades in response to the initial supportive treatment, with clinical or radiological signs of herniation, and with irreversible signs of brain damage such as bilaterally dilated pupils and global ischemia on follow-up CT scan were excluded. The outcome of definitive treatment for 54 patients without herniation who remained with WFNS grade V after the initial supportive treatment were analyzed to seek any factor for a favorable outcome (modified Rankin scale 0–2).

Results

Among 54 patients, 19 (35.2%) had a favorable outcome after a definitive treatment. Multivariate logistic regression analysis showed that the best motor response (BMR) 4 on Glasgow Coma Scale was significantly associated with favorable outcomes (odds ratio, 3.76; 95% confidence interval, 1.09–13.0, p = 0.03). The positive predictive value of BMR 4 was 48.3%.

Conclusions

Albeit being simple, BMR 4 may facilitate the prompt aggressive treatment for patients with WFNS grade V including those with “true” grade V who do not have any clinical and radiological signs of herniation.

中文翻译：

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最佳运动反应可预测患有动脉瘤性蛛网膜下腔出血的“真正”WFNS V 级患者的良好结果

背景

世界神经学会联合会 (WFNS) V 级动脉瘤性蛛网膜下腔出血 (aSAH) 患者超早期手术的普遍应用可能会导致不必要治疗的实施增加。因此，本研究旨在完善患者选择过程，以便及时进行最终治疗。

方法

2011 年 1 月至 2020 年 3 月，我院共收治了 517 名 aSAH 患者。其中，从我们的数据库中确定了 177 名入院时 WFNS 为 V 级的 aSAH 患者。排除初始支持治疗后病情改善、临床或放射学表现有疝气征、以及在随访 CT 扫描中出现双侧瞳孔散大和全脑缺血等不可逆脑损伤征象的患者。对 54 名在初始支持治疗后仍为 WFNS V 级的无疝患者的最终治疗结果进行了分析，以寻找有利结果的任何因素（修改后的 Rankin 量表 0-2）。

结果

在 54 名患者中，19 名 (35.2%) 在明确治疗后获得了良好的结果。多变量逻辑回归分析显示，格拉斯哥昏迷量表上的最佳运动反应 (BMR) 4 与有利结果显着相关（优势比，3.76；95% 置信区间，1.09-13.0，p  = 0.03）。BMR 4 的阳性预测值为 48.3%。

结论

尽管很简单，但 BMR 4 可能有助于对 WFNS V 级患者（包括那些没有任何临床和放射学疝气迹象的“真正”V 级患者）进行及时的积极治疗。