Observational studyActa neurochirurgica2023
Outcomes following poor-grade aneurysmal subarachnoid haemorrhage: a prospective observational study.
Observational study in Acta neurochirurgica, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 7 citations in OpenAlex.
- Outcome predictors in older adults (≥ 65 years) with aneurysmal subarachnoid haemorrhage.Neurosurgical review · 2026Article
- Microsurgical Clipping in Poor-Grade Aneurysmal Subarachnoid Hemorrhage (WFNS Grades 4-5) Patients from Hybrid Neurosurgeons' Perspective: Clinical Profile and Functional Outcomes.Brain sciences · 2026Article
- Outcomes and costs in the management of poor grade subarachnoid haemorrhage.Neurosurgical review · 2025Article
- A nomogram for predicting prognostic risk factors in individuals with poor grade aneurysmal subarachnoid hemorrhage: a retrospective study.Neurosurgical review · 2025Article
- Development and Validation of Machine Learning Models for Outcome Prediction in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage Following Endovascular Treatment.Therapeutics and clinical risk management · 2025Article
- Surgical outcomes of patients with unruptured anterior vs. inferior circulation aneurysms: A meta‑analysis.Medicine internationalArticle
- Impact of surgery within 6 hours on preoperative rerupture and prognosis of poor-grade aneurysmal subarachnoid hemorrhage.Frontiers in neurologyArticle
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Authors and funding
12 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUp to 35% of aneurysmal subarachnoid haemorrhage (aSAH) cases may present as poor grade, defined as World Federation of Neurosurgical Societies (WFNS) grades IV and V. In this study, we evaluate functional outcomes and prognostic factors.
methodsThis prospective study included all patients referred to a national, centralized neurosurgical service with a diagnosis of poor-grade aSAH between 01/01/2016 and 31/12/2019. Multivariable logistic regression models were used to estimate probability of poor functional outcomes, defined as a Glasgow Outcome Scale (GOS) of 1-3 at 3 months.
resultsTwo hundred fifty-seven patients were referred, of whom 116/257 (45.1%) underwent treatment of an aneurysm, with 97/116 (84%) treated within 48 h of referral. Median age was 62 years (IQR 51-69) with a female predominance (167/257, 65%). Untreated patients tended to be older; 123/141 (87%) had WFNS V, 60/141 (45%) unreactive pupils and 21/141 (16%) circulatory arrest. Of all referred patients, poor outcome occurred in 169/230 (73.5%). Unreactive pupils or circulatory arrest conferred a universally poor prognosis, with mortality in 55/56 (98%) and 19/19 (100%), respectively. The risk of a poor outcome was 14.1% (95% CI 4.5-23.6) higher in WFNS V compared with WFNS IV. Age was important in patients without circulatory arrest or unreactive pupils, with risk of a poor outcome increasing by 1.8% per year (95% CI 1-2.7). In patients undergoing aneurysm securement, 48/101 (47.5%) had a poor outcome, with age, rebleeding, vasospasm and cerebrospinal fluid (CSF) diversion being important prognosticators. The addition of serum markers did not add significant discrimination beyond the clinical presentation.
conclusionsThe overall outcomes of WFNS IV and V aSAH remain poor, mainly due to the devastating effects of the original haemorrhage. However, in patients selected for aneurysm securement, good outcomes can be achieved in more than half of patients. Age, pre-intervention rebleeding, vasospasm, and CSF diversion are important prognostic factors.
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