Early identification of patients at risk for symptomatic vasospasm after aneurysmal subarachnoid hemorrhage

Adnan I. Qureshi, Gene Y. Sung, Alexander Y. Razumovsky, Karen Lane, Robert N. Straw, John A. Ulatowski

Research output: Contribution to journalArticlepeer-review

102 Scopus citations

Abstract

Objective: To develop a scheme for early identification of individuals at risk for symptomatic vasospasm after subarachnoid hemorrhage (SAH). Design: Analysis of prospectively collected data from the placebo-treated group in a multicenter clinical trial. Settings: Fifty-four neurosurgical centers in North America. Measurements and Main Results: We identified independent predictors of symptomatic vasospasm using stepwise logistic regression analysis from demographic, clinical, laboratory, and neuroimaging characteristics of the participants. We developed a scoring system (symptomatic vasospasm risk index) based on a combination of these predictors. Out of 283 patients in the analysis (all treated with oral nimodipine), 93 (33%) developed symptomatic vasospasm within 14 days after SAH. There were four independent predictors of symptomatic vasospasm: thickness of subarachnoid clot on computed tomographic scan (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.8-10.0); early rise in middle cerebral artery mean flow velocity (MCA-MFV), defined as a value ≥110 cm/sec recorded on or before post-SAH day 5 (OR, 1.9; 95% CI, 1.1-3.3), Glasgow Coma Scale score <14 (OR, 1.8; 95% CI, 1.1-3.1); and rupture of anterior cerebral or internal carotid artery aneurysm (OR, 1.9; 95% CI, 1.0-3.4). The probability of identifying patients who would develop symptomatic vasospasm (percentage of area under receiver operating characteristics curve ± SEM) was higher with symptomatic vasospasm risk index (68% ± 8%) compared with thickness of clot (62% ± 8%; p = .08) or MCA-MFV (45% ± 7%, p < .05) criteria alone. Conclusions: Patients at high risk for symptomatic vasospasm can be identified early in the course of SAH using a risk index. A risk index based on a combination of variables may represent a predictive paradigm superior to conventionally used criteria based on clot thickness or MCA-MFV criteria.

Original languageEnglish (US)
Pages (from-to)984-990
Number of pages7
JournalCritical care medicine
Volume28
Issue number4
DOIs
StatePublished - Jan 1 2000

Keywords

  • Computed tomography
  • Predictors
  • Subarachnoid hemorrhage
  • Symptomatic vasospasm
  • Transcranial Doppler ultrasound

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