Validation of the SHELTER score after aneurysmal subarachnoid hemorrhage cohort: An observational retrospective study

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-05-25 DOI:10.1016/j.clineuro.2025.108980

Marzia Savi , Eva Vitali , Gaia Furlan , Chiara Faso , Zoe Demailly , Martina Polato , Alessia Degrassi , Ana Carolina Damsceno , Marcos Vinicius Tavares de Magalhães , Vinicius William Costa Dumont , Fabio Silvio Taccone , Elisa Gouvêa Bogossian

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引用次数: 0

Abstract

Objective

Early brain injury (EBI) following aneurysmal subarachnoid hemorrhage (aSAH) occurs in the first 3 days after bleeding is associated with long-term complications and poor neurological outcomes. The aim of this study was to externally validate the SHELTER score, which has been developed to quantify the severity of EBI.

Methods

This is a retrospective single center study of adult aSAH patients consecutively admitted to the Intensive Care Department of Hôpital Universitaire de Bruxelles between January 2015 and December 2023.We calculated the SHELTER score using data from the first 72 h after admission, including age, the World Federation of Neurological Surgeons grade, prehospital cardiopulmonary resuscitation, mydriasis, midline shift, early clinical deterioration, and early ischemia. Unfavorable functional outcome was defined as the modified Rankin scale 3–6 at 6 months.

Results

We included 250 aSAH patients with a mean age of 55 (± 13) years. The SHELTER score demonstrated high predictive accuracy for unfavorable functional outcome with an area under the receiver operating characteristic of 0.80 [95 % confidence interval (CI) 0.75–0.86]. The optimal cut-off point for predicting unfavorable functional outcome was > 5.0, with a sensitivity of 0.57, specificity of 0.88, positive predictive value of 0.77 and negative predictive value of 0.75. In a multivariable analysis, the SHELTER score was independently associated with unfavorable functional outcome (OR 1.70, 95 % CI 1.37–2.10).

Conclusions

The SHELTER score can help identify aSAH patients at high risk of unfavorable functional outcome with good discriminative performance. This score could be used to better stratify patients in future studies investigating interventional strategies aiming at enhancing recovery and long-term prognosis after aSAH.

查看原文本刊更多论文

动脉瘤性蛛网膜下腔出血队列后SHELTER评分的验证：一项观察性回顾性研究

目的动脉瘤性蛛网膜下腔出血（aSAH）后早期脑损伤（EBI）发生于出血后的头3天，伴有长期并发症和较差的神经预后。本研究的目的是从外部验证SHELTER评分，该评分是用来量化EBI的严重程度的。方法对2015年1月至2023年12月期间连续入住Hôpital布鲁塞尔大学重症监护室的成人aSAH患者进行回顾性单中心研究。我们使用入院后72小时 的数据计算SHELTER评分，包括年龄、世界神经外科医生联合会分级、院前心肺复苏、瞳孔、中线移位、早期临床恶化和早期缺血。不良功能结局定义为6个月时改良Rankin量表3-6。结果我们纳入了250例aSAH患者，平均年龄为55（± 13）岁。SHELTER评分对不良功能结果的预测准确度很高，受试者工作特征下的面积为0.80[95 %置信区间（CI） 0.75-0.86]。预测不良功能结局的最佳截断点为>； 5.0，敏感性为0.57，特异性为0.88，阳性预测值为0.77，阴性预测值为0.75。在多变量分析中，SHELTER评分与不良功能结局独立相关（OR 1.70, 95 % CI 1.37-2.10）。结论SHELTER评分有助于识别aSAH患者不良功能结局的高风险，具有良好的鉴别性能。在未来的研究中，该评分可用于更好地对患者进行分层，以研究旨在提高aSAH后恢复和长期预后的干预策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.