The CHESS score: a simple tool for early prediction of shunt dependency after aneurysmal subarachnoid hemorrhage.
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| Title: | The CHESS score: a simple tool for early prediction of shunt dependency after aneurysmal subarachnoid hemorrhage. |
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| Authors: | Jabbarli, R., Bohrer, A. ‐ M., Pierscianek, D., Müller, D., Wrede, K. H., Dammann, P., El Hindy, N., Özkan, N., Sure, U., Müller, O. |
| Source: | European Journal of Neurology. May2016, Vol. 23 Issue 5, p912-918. 7p. 3 Charts, 3 Graphs. |
| Subjects: | Surgical anastomosis, Aneurysm treatment, Subarachnoid hemorrhage, Hydrocephalus, Patients, Therapeutics, Disease risk factors |
| Abstract: | Background and Purpose Acute hydrocephalus is an early and common complication of aneurysmal subarachnoid hemorrhage ( SAH). However, considerably fewer patients develop chronic hydrocephalus requiring shunt placement. Our aim was to develop a risk score for early identification of patients with shunt dependency after SAH. Methods Two hundred and forty-two SAH individuals who were treated in our institution between January 2008 and December 2013 and survived the initial impact were retrospectively analyzed. Clinical parameters within 72 h after the ictus were correlated with shunt dependency. Independent predictors were summarized into a new risk score which was validated in a subsequent SAH cohort treated between January and December 2014. Results Seventy-five patients (31%) underwent shunt placement. Of 23 evaluated variables, only the following five showed independent associations with shunt dependency and were subsequently used to establish the Chronic Hydrocephalus Ensuing from SAH Score ( CHESS, 0-8 points): Hunt and Hess grade ≥ IV (1 point), location of the ruptured aneurysm in the posterior circulation (1 point), acute hydrocephalus (4 points), the presence of intraventricular hemorrhage (1 point) and early cerebral infarction on follow-up computed tomography scan (1 point). The CHESS showed strong correlation with shunt dependency ( P = 0.0007) and could be successfully validated in both internal SAH cohorts tested. Patients scoring ≥6 CHESS points had significantly higher risk of shunt dependency ( P < 0.0001) than other patients. Conclusion The CHESS may become a valuable diagnostic tool for early estimation of shunt dependency after SAH. Further evaluation and external validation will be required in prospective studies. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| Abstract: | Background and Purpose Acute hydrocephalus is an early and common complication of aneurysmal subarachnoid hemorrhage ( SAH). However, considerably fewer patients develop chronic hydrocephalus requiring shunt placement. Our aim was to develop a risk score for early identification of patients with shunt dependency after SAH. Methods Two hundred and forty-two SAH individuals who were treated in our institution between January 2008 and December 2013 and survived the initial impact were retrospectively analyzed. Clinical parameters within 72 h after the ictus were correlated with shunt dependency. Independent predictors were summarized into a new risk score which was validated in a subsequent SAH cohort treated between January and December 2014. Results Seventy-five patients (31%) underwent shunt placement. Of 23 evaluated variables, only the following five showed independent associations with shunt dependency and were subsequently used to establish the Chronic Hydrocephalus Ensuing from SAH Score ( CHESS, 0-8 points): Hunt and Hess grade ≥ IV (1 point), location of the ruptured aneurysm in the posterior circulation (1 point), acute hydrocephalus (4 points), the presence of intraventricular hemorrhage (1 point) and early cerebral infarction on follow-up computed tomography scan (1 point). The CHESS showed strong correlation with shunt dependency ( P = 0.0007) and could be successfully validated in both internal SAH cohorts tested. Patients scoring ≥6 CHESS points had significantly higher risk of shunt dependency ( P < 0.0001) than other patients. Conclusion The CHESS may become a valuable diagnostic tool for early estimation of shunt dependency after SAH. Further evaluation and external validation will be required in prospective studies. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 13515101 |
| DOI: | 10.1111/ene.12962 |
