Comparison of Prognostic Performance between Fisher and Modified Fisher Scales for Patients with Aneurysmal Subarachnoid Hemorrhage

Abstract

Objective The present study aims to assess and compare the prognostic value of these two scales for predicting mortality.

Method We reviewed 172 patients with aneurysmal subarachnoid hemorrhage, who were followed-up for 6 months. The Fisher and modified Fisher scales were evaluated for the prediction of mortality using logistic regressions.

Results The Fisher scale was associated with mortality (odds ratio [OR]: 2; 95% confidence interval [CI]: 1.09–4.05) in the multivariate analysis. The modified Fisher scale was not associated with mortality in the multivariate analysis (OR: 1.39; 95% CI: 0.9–2.29), nor in the univariate analysis (OR: 1.24; 95%CI: 0.87–1.86). There was no significant association between Fisher score and unfavorable functional outcomes (mRS > 2) in the univariate analysis (OR: 1.33; 95%CI: 0.92–1.92), nor in the multivariate analysis (OR: 1.37; 95%CI: 0.92–2.05). There was no significant association between modified Fisher scores and unfavorable functional outcomes in the univariate analysis (OR: 1.16; 95%CI: 0.88–1.52). There was also no significant association in the multivariate analysis (OR: 1.18; 95%CI: 0.88–1.57).

Conclusion Only the Fisher scale was associated with mortality. Neither of the two scales was associated with unfavorable functional outcomes (mRS > 2).

Resumo

Objetivo O presente estudo tem como objetivo avaliar e comparar o valor prognóstico dessas duas escalas para predizer mortalidade.

Método Revisamos 172 pacientes com hemorragia subaracnóidea aneurismática, acompanhados por 6 meses. As escalas de Fisher e modificada de Fisher foram avaliadas para a previsão de mortalidade usando regressões logísticas.

Resultados A escala de Fisher foi associada à mortalidade (odds ratio [OR]: 2; intervalo de confiança [IC] 95%: 1.09–4.05) na análise multivariada. A escala Fisher modificada não foi associada à mortalidade na análise multivariada (OR: 1.39; IC95%: 0.9–2.29), nem na análise univariada (OR: 1.24; IC95%: 0.87–1.86). Não houve associação significativa entre o escore de Fisher e resultados funcionais desfavoráveis (mRS > 2) na análise univariada (OR: 1.33; IC95%: 0.92–1.92), nem na análise multivariada (OR: 1.37; IC95%: 0.92–2.05). Não houve associação significativa entre os escores modificados de Fisher e resultados funcionais desfavoráveis na análise univariada (OR: 1.16; IC95%: 0.88–1.52). Também não houve associação significativa na análise multivariada (OR: 1.18; IC95%: 0.88–1.57).

Conclusão Apenas a escala de Fisher foi associada à mortalidade. Nenhuma das duas escalas foi associada a resultados funcionais desfavoráveis (mRS > 2).

Keywords

fisher - modified fisher - subarachnoid hemorrhage - intracranial aneurysm - prognosis

Palavras-chave

escala fisher - escala fisher modificada - hemorragia subaracnóidea - aneurismas intracranianos - prognóstico

Ethical Standards

The present research project was approved by the Ethics and Research Committee of the Hospital das Clínicas of FMUSP. Online registration CAPPesq: 15226 approved 06/20/2016. Approved on the Brazil platform CAAE number: 61719416.6.0000.0068

Disclosure

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in the present article.

Originality

I, Nícollas Nunes Rabelo, certify that this manuscript is a unique submission and is not being considered for publication with any other source in any medium.

Publication History

Received: 14 April 2023

Accepted: 05 July 2023

Article published online:
27 October 2023

• References

• 1 Findlay JM, Nisar J, Darsaut T. Cerebral Vasospasm: A Review. Can J Neurol Sci 2016; 43 (01) 15-32
• 2 Fang YJ, Mei SH, Lu JN. et al. New risk score of the early period after spontaneous subarachnoid hemorrhage: For the prediction of delayed cerebral ischemia. CNS Neurosci Ther 2019; 25 (10) 1173-1181
• 3 Miller BA, Turan N, Chau M, Pradilla G. Inflammation, vasospasm, and brain injury after subarachnoid hemorrhage. BioMed Res Int 2014;2014;
• 4 Dabus G, Nogueira RG. Current options for the management of aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm: a comprehensive review of the literature. Intervent Neurol 2013; 2 (01) 30-51
• 5 Claassen J, Bernardini GL, Kreiter K. et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke 2001; 32 (09) 2012-2020
• 6 Frontera JA, Claassen J, Schmidt JM. et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery 2006; 59 (01) 21-27 , discussion 21–27
• 7 Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980; 6 (01) 1-9
• 8 Lindvall P, Runnerstam M, Birgander R, Koskinen LOD. The Fisher grading correlated to outcome in patients with subarachnoid haemorrhage. Br J Neurosurg 2009; 23 (02) 188-192
• 9 Ogilvy CS, Cheung AC, Mitha AP, Hoh BL, Carter BS. Outcomes for surgical and endovascular management of intracranial aneurysms using a comprehensive grading system. Neurosurgery 2006; 59 (05) 1037-1042 , discussion 1043
• 10 Cedzich C, Roth A. Neurological and psychosocial outcome after subarachnoid haemorrhage, and the hunt and hess scale as a predictor of clinical outcome. Zentralbl Neurochir 2005; 66 (03) 112-118