Evidence map›Paper›PMID 42563043›Full record

ArticleNeurocritical care2026

Beyond the Initial Ictus: Timing of WFNS Grade Assessment and Outcome Prediction in Aneurysmal Subarachnoid Hemorrhage.

Sebastian L Wyss, Jorn Fierstra, Victor Staartjes, Stefanos Voglis, Luca Regli, Zsolt Kulcsar, Emanuela Keller, Jan F Willms, Nicolai Maldaner

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Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Sebastian L WyssDepartment of Neurosurgery & Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Jorn FierstraDepartment of Neurosurgery & Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Victor StaartjesDepartment of Neurosurgery & Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Stefanos VoglisDepartment of Neurosurgery & Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Luca RegliDepartment of Neurosurgery & Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Zsolt KulcsarDepartment of Neuroradiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Emanuela KellerNeurocritical Care Unit, Department of Neurosurgery & Clinical Neuroscience Center, Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Jan F Willms *Neurocritical Care Unit, Department of Neurosurgery & Clinical Neuroscience Center, Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Nicolai Maldaner *Department of Neurosurgery & Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. nicolai.maldaner@usz.ch.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTo identify the clinical timepoint of World Federation of Neurosurgical Societies (WFNS) grading that provides the highest prognostic accuracy for short- and long-term outcomes in aneurysmal subarachnoid hemorrhage (aSAH).

methodsIn this cohort study of 389 patients, WFNS grades were recorded at first medical contact, hospital admission, immediately pre-occlusion, and 48 h post-occlusion. Functional outcome was assessed using the Glasgow Outcome Scale-Extended (GOSE) and modified Rankin Scale (mRS) at discharge, 1 year, and at least 2 years after ictus. Prognostic performance was evaluated using receiver operating characteristic (ROC) analysis and compared across timepoints with DeLong's test.

resultsPrognostic accuracy varied significantly between assessment timepoints. Across all outcomes, WFNS grading at 48 h post-occlusion demonstrated the highest discriminative power. For functional outcome at discharge, the area under the curve (AUC) reached 0.817 for GOSE and 0.845 for mRS, exceeding all values obtained from earlier assessments. The prognostic accuracy remained superior at the 1 year follow-up (GOSE AUC 0.844, mRS AUC 0.823) and at long-term follow-up after 2 years or more (GOSE AUC 0.819, mRS AUC 0.784). DeLong's Test confirmed the significantly better predictive performance 48 h post-occlusion compared with all earlier timepoints, whereas no significant differences were observed among the earlier timepoints.

conclusionsThe WFNS assessment at 48 h post-occlusion provides a better prediction of both short- and long-term functional outcomes after aSAH compared with earlier evaluations. This timepoint may more accurately reflect a stabilized neurological status and could be used in addition to the WFNS scale obtained at admission.

Indexed as

Clinical prediction ruleFollow-up studiesPrognostic factorsSubarachnoid hemorrhage, aneurysmal

Identifiers

PMID42563043

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.