A Method for Reducing Misclassification in the Extended Glasgow Outcome Score

Abstract OBJECTIVE: Proximal posterior inferior cerebellar artery (PICA) aneurysms represent a subset of posterior circulation aneurysms that can be routinely treated with either clipping or coiling. The literature contains limited numbers of patients with proximal PICA aneurysms treated with endovascular surgery. We report our experience with endovascular surgery of proximal PICA aneurysms with emphasis on patients with poor Hunt-Hess grades. METHODS: We reviewed 31 consecutive patients with proximal PICA aneurysms who were treated with endovascular surgery. The following data were analyzed: age, sex, size of aneurysm, Hunt-Hess grade at presentation, Fisher grade at presentation, angiographic result after embolization, complications, number of days hospitalized, duration of follow-up, angiographic follow-up results, and Glasgow Outcome Score at follow-up. RESULTS: Excellent angiographic occlusion was achieved in 30 of 31 (97%) patients. Clinical follow-up with Glasgow Outcome Score was performed on every patient an average of 10 months later. Twenty-one of 31 (68%) patients had good outcomes (Glasgow Outcome Score I or II) at follow-up. Of the patients who presented with a favorable clinical grade (Hunt-Hess 0–III), 13 of 15 (87%) had good outcomes at follow-up. Of the patients who presented with a poor clinical grade (Hunt-Hess Grade IV or higher), 8 of 16 (50%) had good outcomes at follow-up. CONCLUSION: This series demonstrates the safety and efficacy of endovascular surgery for proximal PICA aneurysms. Many patients with poor Hunt-Hess grades from ruptured PICA aneurysms ultimately had a good outcome. This could be secondary to early, aggressive treatment of hydrocephalus and the minimally invasive nature of the endovascular approach.

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Determine the Outcome of Traumatic Extradural Hematoma and to Compare the Outcome of Small and Large Size Extradural Hematoma

10.53350/pjmhs2115103363 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3363-3365

Author(s):

Muhammad Pervez Khan ◽

Muhammad Anwar

Keyword(s):

Glasgow Outcome Score ◽

Extradural Hematoma ◽

Hematoma Volume ◽

Common Cause ◽

Descriptive Case Study ◽

Large Size ◽

Outcome Score ◽

Male Patients

Objective: The aim of this study is to determine the outcome of traumatic extradural hematoma and to compare the outcome of small and large size extradural hematoma. Study Design: Descriptive case study Place and Duration: Study was conducted at the department of Neurosurgery, Saidu Teaching Hospital, Saidu Sharif, Swat for duration of two years from January 2016 to December 2017. Methods: Total one hundred and forty patients of both genders with ages 2-70 years were presented. Patients had traumatic extradural hematoma within duration first 24 hours were included and admitted through the emergency department. Detailed demographics of enrolled cases age, sex, GCS on arrival and cause of injury were recorded after taking informed written consent. CT scan of all the patients was done for diagnosis. Glasgow Outcome Score (GOS) was used for determination of outcomes. SPSS 23.0 version was used to analyze the data. Results: There were 110 (78.6%) male patients and 30 (21.4%) patients were females. Mean age of the patients was 32.78±10.43 years. RTA was the most common cause found in 84 (60%) followed by falling 29 (20.7%) and assault in 27 (19.3%). Small size hematoma volume among 100 (71.4%) cases and large size was in 40 (28.6%) patients. According to Glasgow outcome score, 24 (17.1%) cases had 1-3 score and 116 (82.9%) cases had 4-5 score. Mean GOS was 4.01±1.12. We found successful outcomes among 116 (82.9%) cases in which majority of the patients were from small size extradural hematoma. Conclusion: We concluded in this study that a significant relationship exists between the volume of extradural hematoma and both the clinical and functional outcome. Prognosis becomes increasingly worse with rising extradural hematoma size. Keywords: Traumatic Brain Injury, Extradural Hematoma, Glasgow Outcome Score

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The Modified Glasgow Outcome Score for the prediction of outcome in patients after cardiac arrest: a prospective clinical proof of concept study

Clinical Research in Cardiology ◽

10.1007/s00392-012-0423-7 ◽

2012 ◽

Vol 101 (7) ◽

pp. 533-543 ◽

Cited By ~ 10

Author(s):

Obaida R. Rana ◽

Jörg W. Schröder ◽

Julia S. Kühnen ◽

Esra Saygili ◽

Christopher Gemein ◽

...

Keyword(s):

Cardiac Arrest ◽

Glasgow Outcome Score ◽

Proof Of Concept ◽

Prediction Of Outcome ◽

Concept Study ◽

Outcome Score

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Intracranial pressure levels and single wave amplitudes, Glasgow Coma Score and Glasgow Outcome Score after subarachnoid haemorrhage

Acta Neurochirurgica ◽

10.1007/s00701-006-0908-0 ◽

2006 ◽

Vol 148 (12) ◽

pp. 1267-1276 ◽

Cited By ~ 22

Author(s):

P. K. Eide ◽

W. Sorteberg

Keyword(s):

Intracranial Pressure ◽

Subarachnoid Haemorrhage ◽

Glasgow Coma Score ◽

Glasgow Outcome Score ◽

Single Wave ◽

Outcome Score

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Depression after Traumatic Brain Injury as a Function of Glasgow Outcome Score

Journal of Clinical and Experimental Neuropsychology ◽

10.1076/jcen.20.2.270.1172 ◽

1998 ◽

Vol 20 (2) ◽

pp. 270-279 ◽

Cited By ~ 28

Author(s):

Carol McCleary ◽

Paul Satz ◽

David Forney ◽

Roger Light ◽

Kenneth Zaucha ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Glasgow Outcome Score ◽

Outcome Score

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Face-to-Face Versus Telephonic Extended Glasgow Outcome Score Testing After Traumatic Brain Injury

Journal of Head Trauma Rehabilitation ◽

10.1097/htr.0000000000000622 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Sebastiaan M. Bossers ◽

Joukje van der Naalt ◽

Bram Jacobs ◽

Lothar A. Schwarte ◽

Robert Verheul ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Glasgow Outcome Score ◽

Face To Face ◽

Outcome Score

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Correlation of Glasgow outcome score to Glasgow coma score assessed at admission

International Surgery Journal ◽

10.18203/2349-2902.isj20163172 ◽

2016 ◽

pp. 1959-1963

Author(s):

Harsha Kodliwadmath ◽

Sanjay Koppad ◽

Mallikarjun Desai ◽

Suresh Badiger

Keyword(s):

Glasgow Coma Score ◽

Glasgow Outcome Score ◽

Outcome Score

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Outcome of Head Injury Patients Undergoing Surgical Management: A Tertiary Level Experience

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i4.6345 ◽

2012 ◽

Vol 9 (4) ◽

pp. 283-285

Author(s):

A Shrestha ◽

R M Joshi ◽

A Thapa ◽

U P Devkota ◽

D N Gongal

Keyword(s):

Head Injury ◽

Severe Head Injury ◽

Surgical Intervention ◽

Head Injuries ◽

Glasgow Outcome Score ◽

Injury Mortality ◽

Outcome Score ◽

Injury Group ◽

Neurosurgical Patient ◽

Severity Of Injury

Background Head injury is the major cause of death in a neurosurgical patient. Objective To find the outcome, and treatment modality affecting the outcome in patients with head injury. Methods Nine hundred eighty seven patients presenting to National Institute of Neurological and Allied Sciences, Kathmandu, with head injury from September 2009 to October 2010 were included in the study. Patients were categorized according to post resuscitation Glasgow Coma Score. Outcome was assessed at discharge using Glasgow Outcome Score and analyzed for any correlation with modality of treatment and severity of injury. Results Among 987 patients with head injury,152 (15.4%) had severe, 126 (12.8%) had moderate and 709 (71.8%) had mild head injuries. Three hundred twelve (31.6%) patients required definitive and supportive surgical intervention. One hundred eighty two required cranial surgical intervention. Overall mortality was 10% (99), 137 patients (13.9%) had unfavorable outcome and 850 (86.1%) had favorable Glasgow Outcome Score of 4 and 5. Mortality was 53.2%, 9.5% and 0.8% in severe, moderate and mild head injury group respectively. Mortality rate was significantly higher (64.6%) in severe head injury group managed conservatively than those in same group treated with supportive and definite surgical intervention (44.8%) (p=0.016). Conclusion Mortality in head injury patients depend upon severity of injury. Mortality in severe head injury group can be reduced by supportive and definite surgical intervention.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6345 Kathmandu Univ Med J 2011;9(4):283-5

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Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.105605 ◽

2013 ◽

Vol 04 (01) ◽

pp. 24-28 ◽

Cited By ~ 19

Author(s):

P P Saramma ◽

P Girish Menon ◽

Adesh Srivastava ◽

P Sankara Sarma

Keyword(s):

Subarachnoid Hemorrhage ◽

Serum Sodium ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Glasgow Outcome Score ◽

World Federation ◽

Anterior Communicating Artery ◽

Sree Chitra Tirunal Institute ◽

Outcome Score ◽

The Mean ◽

Clinically Significant

ABSTRACT Background: Hyponatremia is the most common electrolyte abnormality seen in patients with aneurysmal SAH. Clinically significant hyponatremia (Serum Sodium <131 mEq/L) which needs treatment, has been redefined recently and there is a paucity of outcome studies based on this. This study aims to identify the mean Serum Sodium (S.Na+) level and its duration among inpatients with SAH and to identify the relationship between hyponatremia and the outcome status of patients undergoing surgery for SAH. Materials and Methods: This outcome study is undertaken in the department of neurosurgery, The Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. Medical records of all patients with SAH from 1st January to 31st July 2010 were reviewed. Preoperative status was assessed using World Federation of Neurosurgical Societies (WFNS) grading system. Discharge status was calculated using the Glasgow outcome score scale. Results: Fifty nine patients were included in the study and 53 (89.8%) of them have undergone surgical treatment. Hyponatremia was observed in 22 of 59 patients (37%). The mean Sodium level of hyponatremic patients was 126.97 mEq/L for a median duration of two days. Glasgow outcome score was good in 89.8% of patients. We lost two patients, one of whom had hyponatremia and vasospasm. Conclusion: Hyponatremia is significantly associated with poor outcome in patients with SAH. Anticipate hyponatremia in patients with aneurysmal subarachnoid hemorrhage, timely detect and appropriately treat it to improve outcome. It is more common in patients who are more than 50 years old and whose aneurysm is in the anterior communicating artery. Our comprehensive monitoring ensured early detection and efficient surgical and nursing management reduced morbidity and mortality.

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No Association between Intraoperative Hypothermia or Supplemental Protective Drug and Neurologic Outcomes in Patients Undergoing Temporary Clipping during Cerebral Aneurysm Surgery

Anesthesiology ◽

10.1097/aln.0b013e3181c5e28f ◽

2010 ◽

Vol 112 (1) ◽

pp. 86-101 ◽

Cited By ~ 50

Author(s):

Bradley J. Hindman ◽

Emine O. Bayman ◽

Wolfgang K. Pfisterer ◽

James C. Torner ◽

Michael M. Todd ◽

...

Keyword(s):

Odds Ratio ◽

Glasgow Outcome Score ◽

Aneurysm Surgery ◽

Regression Methods ◽

Neurologic Outcomes ◽

Outcome Score ◽

Intraoperative Hypothermia ◽

Surgery Trial ◽

Temporary Clipping

Background Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surgery (temporary clipping) is not established. Methods A post hoc analysis of patients from the Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate and multivariate logistic regression methods were used to test for associations between hypothermia, supplemental protective drug, and short- (24-h) and long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better outcome. Results Patients undergoing temporary clipping (n = 441) were assigned to intraoperative hypothermia (33.3 degrees +/- 0.8 degrees C, n = 208) or normothermia (36.7 degrees +/- 0.5 degrees C, n = 233), with 178 patients also receiving supplemental protective drug (thiopental or etomidate) during temporary clipping. Three months after surgery, 278 patients (63%) had good outcome (Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043, 95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio = 1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score. The effect of supplemental protective drug did not significantly vary with temperature. The effects of hypothermia and protective drug did not significantly vary with temporary clip duration. Similar findings were made for 24-h neurologic status and 3-month Neuropsychological Composite Score. Conclusion In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.

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