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

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.