Which grading system better predicts 28-day mortality in nontraumatic subarachnoid hemorrhage: Traditional clinical scores or combined grading systems?

Background: The objective was to investigate the predictive ability of traditional clinical, radiological scores, and combined grading systems for 28-day mortality in patients with nontraumatic subarachnoid hemorrhage (SAH).

Methods: This multicenter cohort study enrolled 451 adults who presented to the emergency departments of six major tertiary care hospitals in Istanbul with nontraumatic aneurysmal SAH. Demographic data; clinical characteristics; and traditional clinical grading scores were recorded, including the Glasgow Coma Scale (GCS), Hunt and Hess scale (HHS), World Federation of Neurological Surgeons (WFNS) scale, modified Fisher scale (mFS), and two combined grading systems, the VASOGRADE and Ogilvy-Carter scales. These data were compared between survivors and nonsurvivors.

Results: A total of 451 patients were included, comprising 242 males (53.7%) and 209 females (46.3%), with a mean ± SD age of 54.8 ± 14.1 years. The overall mortality rate was 28.2% (n = 127). Nonsurvivors had significantly lower mean GCS scores and higher HHS, WFNS, mFS, and Ogilvy-Carter scores compared to survivors (all p < 0.001). A significantly higher proportion of nonsurvivors were categorized in the red group based on VASOGRADE (p < 0.001). Multivariable logistic regression analysis identified age, sex, HHS, mFS, WFNS, and VASOGRADE as independent predictors of mortality. The WFNS scale emerged as the most reliable predictor of mortality with an area under the curve of 0.878.

Conclusions: Although the GCS and Ogilvy-Carter scales effectively distinguished survivors from nonsurvivors, they were not independent predictors of mortality. The WFNS scale was identified as the most reliable predictor of mortality in aneurysmal SAH patients, followed by the mFS and HHS.