Association between Hunt and Hess Grade and the Modified Rankin Scale among Patients with Non-Traumatic Subarachnoid Hemorrhage Open Access

Medani, Khalid (Fall 2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/7p88cg53c?locale=en
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Abstract

Background: Hunt and Hess (HH) grading scale is the most utilized scale to describe the clinical status of patients admitted with non-traumatic subarachnoid hemorrhage (SAH). Upon discharge, the modified Rankin Scale (mRS) is used to evaluate patient’s outcome. The relationship between HH on admission and mRS upon discharge has not been evaluated before. In this study we aimed to evaluate this relationship among patients admitted to the NeuroIntensive Care Unit (NICU).

• Methods: This retrospective analysis was based on data from patients with nontraumatic SAH admitted to Emory University Hospital NICU during the period 2006-2016. The data included patients’ demographics, smoking status, associated diseases related to SAH, year of admission, admission’s HH grade and discharge’s mRS. Univariate and multivariate binary logistic regression analyses were performed to obtain crude and adjusted odds ratios. Rates of HH grade on admission and mRS upon discharge over time were also determined to describe trends in medical care at this institution.

• Results: 2672 patients were enrolled in the study. The median age was 54 years (range: 12-101). 66% of patients were female, 42% were white and 30% were black. 26% of the patients were smokers, 54% hypertensive and 12% were diabetic. 8% had a history of coronary artery disease or myocardial infarction (CAD/MI) and 14% had a history of hyperlipidemia. In the multivariable analysis, the odds ratio for bad outcome mRS (3-6) was 5.7 (95% C.I: 4.6-7.0) and 66.0 (95% CI: 44.0-99.1) for the intermediate-grade (III) and high-grade (IV and V) HH groups respectively, when compared to the low-grade (I and II) HH group. Age, hypertension and diabetes were found to be negatively associated with the mRS outcome, while hyperlipidemia was found to be positively associated. Gender, race, smoking status and history of CAD/MI were not related to the mRS outcome. A positive trend for a better mRS outcome was observed across years. There was no evidence that the significant trend was related to HH grade on admission, suggesting better medical and/or surgical management for this patient population across years (p=0.18 for interaction between HH grade and year).

• Conclusion: HH grading scale on admission is associated with the mRS outcome upon discharge for patients with non-traumatic SAH. Models predicting the probability of a good mRS outcome could be created and validated based on the HH grade on admission, age, hypertension, diabetes and hyperlipidemia status. 

Table of Contents

Background........................................................................ 1

Methods............................................................................. 

Results............................................................................... 

Discussion........................................................................ 10

References........................................................................ 12

Table 1 & 2 ...................................................................... 14

Table 3.............................................................................. 15

Table 4.............................................................................. 16

Figure 3 & 4..................................................................... 17

Figure 5............................................................................ 18 

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