The SAH Score: An Outcome Prediction Model (S12.004)

OBJECTIVE: Create a novel “SAH score” and compare the accuracy of mortality prediction with the Hunt & Hess Grade and World Federation of Neurological Surgeons (WFNS) scale. BACKGROUND: The Hunt & Hess Grade and WFNS scale are commonly used to predict mortality following aneurysmal subarachnoid hemorrhage (aSAH). DESIGN/METHODS: Prospectively collected data of aSAH patients admitted to our institution between 1991-2009 were reviewed. We analyzed factors impacting in-hospital SAH mortality using multiple logistic regression analysis. Scores were 9weighted9 based on relative risk of mortality following stratification of each of these variables. GCS was subdivided into subgroups of 3-4, 5-8, 9-13 and 14-15; age was split into 4 subgroups: 18-49, 50-69, 70-79 and >80. Medical co-morbidities were subdivided into none, 1 or >/=2 based on co-morbidities derived from Charlson index or other factors (hypertension, cocaine) historically known to impact SAH outcomes. RESULTS: 1134 patients were included; all-cause SAH hospital mortality was 18.3%. Admission GCS, age and medical co-morbidities significantly impacted mortality following multivariate analysis (P 80; score=3). Relationship of co-morbidities and mortality was 9%(none; score=0), 17%(one; score=1) and 32%(two/more; score=2). Summated Scores ranged from 0-8 with progressively escalating mortality at higher scores (0=2%/ 1=6%/ 2=8%/ 3=13%/ 4=30%/ 5=54%/ 6=80%/ 7=89%/ 8=100%). PPV for scores in the range 7-8 was 90% while 6-8 was 84%. NPV was 94% for range 0-2 and 91% for 0-3. The area under the curve (AUC) for the SAH score was 0.822 (good accuracy), compared to WFNS scale (AUC 0.777, fair accuracy) and Hunt & Hess Grade (AUC 0.771, fair accuracy). CONCLUSIONS: The SAH score is more accurate in predicting SAH mortality compared to Hunt & Hess Grade and WFNS scale. Disclosure: Dr. Kowalski has nothing to disclose. Dr. Chang has nothing to disclose. Dr. Caserta has nothing to disclose. Dr. Nyquist has nothing to disclose. Dr. Carhuapoma has nothing to disclose. Dr. Tamargo has nothing to disclose. Dr. Naval has received personal compensation for activities with EKR Therapeutics as a speaker.