The SAFARI Score to Assess the Risk of Convulsive Seizure During Admission for Aneurysmal Subarachnoid Hemorrhage. Issue 6 (June 2018)

• Record Type: Journal Article
• Authors: Jaja, Blessing N R; Schweizer, Tom A; Claassen, Jan; Le Roux, Peter; Mayer, Stephan A; Macdonald, Loch R
• Is Part Of: Neurosurgery. Volume 82:Issue 6(2018)
• Publication Date: 2018-06
• Subjects: Intracranial aneurysm -- Prognosis -- Risk factors -- Seizure -- Subarachnoid hemorrhage; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyx334
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND : Seizure is a significant complication in patients under acute admission for aneurysmal SAH and could result in poor outcomes. Treatment strategies to optimize management will benefit from methods to better identify at‐risk patients. OBJECTIVE : To develop and validate a risk score for convulsive seizure during acute admission for SAH. METHODS : A risk score was developed in 1500 patients from a single tertiary hospital and externally validated in 852 patients. Candidate predictors were identified by systematic review of the literature and were included in a backward stepwise logistic regression model with in‐hospital seizure as a dependent variable. The risk score was assessed for discrimination using the area under the receiver operator characteristics curve (AUC) and for calibration using a goodness‐of‐fit test. RESULTS : The SAFARI score, based on 4 items (age ≥ 60 yr, seizure occurrence before hospitalization, ruptured aneurysm in the anterior circulation, and hydrocephalus requiring cerebrospinal fluid diversion) had AUC = 0.77, 95% confidence interval (CI): 0.73‐0.82 in the development cohort. The validation cohort had AUC = 0.65, 95% CI 0.56‐0.73. A calibrated increase in the risk of seizure was noted with increasing SAFARI score points. CONCLUSION : The SAFARI score is a simple tool that adequately stratified SAH patients according to their risk for seizure using a few readily derived predictor items. It may contribute to a more individualized management of seizure following SAH.