The PRESSURE score to predict decompressive craniectomy after aneurysmal subarachnoid haemorrhage. Issue 2 (17th September 2020)

• Record Type: Journal Article
• Authors: Jabbarli, Ramazan; Darkwah Oppong, Marvin; Roelz, Roland; Pierscianek, Daniela; Shah, Mukesch; Dammann, Philipp; Scheiwe, Christian; Kaier, Klaus; Wrede, Karsten H; Beck, Jürgen; Sure, Ulrich
• Is Part Of: Brain communications. Volume 2:Issue 2(2020)
• Publication Date: 2020-09-17
• Subjects: subarachnoid haemorrhage -- decompressive craniectomy -- risk score -- prediction -- outcome; 616
• DOI: 10.1093/braincomms/fcaa134
• Languages: English
• ISSNs: 2632-1297

Abstract

Abstract: The prognosis of patients with aneurysmal subarachnoid haemorrhage requiring decompressive craniectomy is usually poor. Proper selection and early performing of decompressive craniectomy might improve the patients' outcome. We aimed at developing a risk score for prediction of decompressive craniectomy after aneurysmal subarachnoid haemorrhage. All consecutive aneurysmal subarachnoid haemorrhage cases treated at the University Hospital of Essen between January 2003 and June 2016 (test cohort) and the University Medical Center Freiburg between January 2005 and December 2012 (validation cohort) were eligible for this study. Various parameters collected within 72 h after aneurysmal subarachnoid haemorrhage were evaluated through univariate and multivariate analyses to predict separately primary (PrimDC) and secondary decompressive craniectomy (SecDC). The final analysis included 1376 patients. The constructed risk score included the following parameters: intracerebral (' P arenchymal') haemorrhage (1 point), ' R apid' vasospasm on angiography (1 point), E arly cerebral infarction (1 point), aneurysm S ac > 5 mm (1 point), clipping (' S urgery', 1 point), age U nder 55 years (2 points), Hunt and Hess grade ≥ 4 (' R educed consciousness', 1 point) and E xternal ventricular drain (1 point). The PRESSURE score (0–9 points) showed high diagnostic accuracy for the prediction of PrimDC and SecDC in the test (area under the curve = 0.842/0.818) and validation cohorts (area under the curve = 0.903/0.823), respectively. 63.7% of the patients scoring ≥6 points required decompressive craniectomy (versus 12% for the PRESSURE < 6 points, P < 0.0001). In the subgroup of the patients with the PRESSURE ≥6 points and absence of dilated/fixed pupils, PrimDC within 24 h after aneurysmal subarachnoid haemorrhage was independently associated with lower risk of unfavourable outcome (modified Rankin Scale >3 at 6 months) than in individuals with later or no decompressive craniectomy ( P < 0.0001). Our risk score was successfully validated as reliable predictor of decompressive craniectomy after aneurysmal subarachnoid haemorrhage. The PRESSURE score might present a background for a prospective randomized clinical trial addressing the utility of early prophylactic decompressive craniectomy in aneurysmal subarachnoid haemorrhage. Abstract : In this pooled analysis of 1376 patients with subarachnoid haemorrhage, we developed and successfully validated a risk score for early prediction of decompressive craniectomy, the PRESSURE score. We recommend a prospective randomized clinical trial addressing the utility of early prophylactic decompressive craniectomy after subarachnoid haemorrhage using the PRESSURE score. Graphical Abstract: