Early Motor Glasgow Coma Scale Predicts Unfavorable Functional Outcome after Poor-Grade Subarachnoid Hemorrhage.

Background: We assessed whether the motor component of the Glasgow Coma Scale (GCSm) is independently associated with unfavorable outcomes in aggressively treated poor-grade subarachnoid hemorrhage (SAH) patients.

Methods: Retrospective cohort of poor-grade SAH patients (World Federation of Neurosurgical Societies (WFNS) grades IV and V). The best GCSm score achieved within 24 h of admission was stratified into four categories (<4, 4, 5 or 6). Outcomes were classified as favorable [modified Rankin Scale (mRS) ≤ 2] or unfavorable (mRS ≥ 3). Multivariable logistic regression was performed to identify independent predictors of unfavorable outcome.

Results: A total of 179 patients were admitted during the study period (mean age 55.9 ± 12.1; 68.2% female). Thirty-three patients (33/179 - 18%) died before aneurysm treatment, one patient had missing GCSm data at 24 h and sixteen patients (16/179; 9%) were lost to follow-up. One hundred and twenty-nine patients (129/179 - 72%) were included in the final analysis. No patient with GCSm < 4 had a favorable outcome (sensitivity 22.4%, specificity 100%, positive predictive value 100% and negative predictive value 67.8% for unfavorable outcome). Delayed cerebral ischemia-related cerebral infarction (odds ratio (OR) 4.06; 1.56-11.11 95% CI, p = 0.004) and the best GCSm score were independently associated with unfavorable outcome. There was a stepwise decrease in the rate of unfavorable outcome from GCSm < 4 to GCSm = 6 (<4 = 100%; 4 = 80%; 5 = 46% and 6 = 20%). Each one-point decrease in GCSm score was associated with an OR of 3.52 (1.77-7.92 95% CI, p = < 0.001) for unfavorable outcome.

Conclusion: The GCSm score was independently associated with unfavorable outcome. All patients with a GCSm score < 4 experienced an unfavorable outcome.