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Prediction of 60 day case-fatality after aneurysmal subarachnoid haemorrhage: Results from the International Subarachnoid Aneurysm Trial (ISAT)

 
: Risselada, R.; Lingsma, H.F.; Bauer-Mehre, A.; Friedrich, C.M.; Molyneux, A.J.; Kerr, R.S.; Yarnold, J.; Sneade, M.; Steyerberg, E.W.; Sturkenboom, M.C.

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Postprint urn:nbn:de:0011-n-1187102 (181 KByte PDF)
MD5 Fingerprint: 5617edad5075b313a65b48ebbe9482ee
The original publication is available at springerlink.com
Erstellt am: 16.9.2010


European journal of epidemiology 25 (2010), Nr.4, S.261-266
ISSN: 0393-2990
ISSN: 1573-7284
Englisch
Zeitschriftenaufsatz, Elektronische Publikation
Fraunhofer SCAI ()

Abstract
Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with substantial case-fatality. Our purpose was to examine which clinical and neuro-imaging characteristics, available on admission, predict 60 day case-fatality in aSAH and to evaluate performance of our prediction model. We performed a secondary analysis of patients enrolled in the International Subarachnoid Aneurysm Trial (ISAT), a randomised multicentre trial to compare coiling with clipping in aSAH patients. Multivariable logistic regression analysis was used to develop a prognostic model to estimate the risk of dying within 60 days from aSAH based on clinical and neuro-imaging characteristics. The model was internally validated with bootstrapping techniques. The study population comprised of 2,128 patients who had been randomised to either endovascular coiling or neurosurgical clipping. In this population 153 patients (7.2%) died within 60 days. World Federation of Neurosurgical Societies (WFNS) grade was the most important predictor of case-fatality, followed by age, lumen size of the aneurysm and Fisher grade. The model discriminated reasonably between those who died within 60 days and those who survived (c statistic = 0.73), with minor optimism according to bootstrap re-sampling (optimism corrected c statistic = 0.70). Several strong predictors are available to predict 60 day case-fatality in aSAH patients who survived the early stage up till a treatment decision; after external validation these predictors could eventually be used in clinical decision making.

: http://publica.fraunhofer.de/dokumente/N-118710.html