The Subarachnoid Hemorrhage Early Brain Edema Score Predicts Delayed Cerebral Ischemia and Clinical Outcomes

• Published in: Neurosurgery Vol. 83; no. 1; pp. 137 - 145
• Main Authors: Ahn, Sung-Ho, Savarraj, Jude P, Pervez, Mubashir, Jones, Wesley, Park, Jin, Jeon, Sang-Beom, Kwon, Sun U, Chang, Tiffany R, Lee, Kiwon, Kim, Dong H, Day, Arthur L, Choi, H Alex
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.07.2018; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Adult; Aged; Aneurysms; Brain Edema - diagnostic imaging; Brain Edema - etiology; Brain injuries; Brain Ischemia - diagnostic imaging; Brain Ischemia - etiology; CAT scans; Cerebral edema; Cerebral ischemia; Clinical outcomes; Cohort Studies; Diagnostic imaging; Edema; Female; Hemorrhage; Humans; Ischemia; Male; Medical prognosis; Medical research; Middle Aged; Neurosurgery; Patient outcomes; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Stroke; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - complications; Tomography; Tomography, X-Ray Computed - methods; CT; Delayed cerebral ischemia; Prognosis; Early brain injury; Subarachnoid hemorrhage
• DOI: 10.1093/neuros/nyx364
• ISSN: 0148-396X; 1524-4040

Abstract BACKGROUND Early brain injury (EBI) after subarachnoid hemorrhage (SAH) is an important determinant of clinical outcomes. However, a major hindrance to studies of EBI is the lack of radiographic surrogate marker. OBJECTIVE To propose a scoring system based on early changes in clinically obtained computed tomography (CT), called the Subarachnoid hemorrhage Early Brain Edema Score (SEBES). METHODS Patients with spontaneous aneurysmal SAH and a CT within 24 h of ictus were included. We defined SEBES as a scale of 0 to 4 points according to the (1) absence of visible sulci caused by effacement of sulci or (2) absence of visible sulci with disruption of the gray–white matter junction at 2 predetermined levels in each hemisphere. Prognostic value of the SEBES grade for the prediction of delayed cerebral ischemia (DCI) and unfavorable outcomes was assessed. A separate cohort of patients was used as a validation cohort. RESULTS Of the 164 subjects in our study, high-grade SEBES (3 or 4 points) was identified in 48 patients (29.3%). CT interobserver reliability of SEBES grades was high with a Kappa value of 0.89. After adjusting for covariables, SEBES was identified as an independent predictor of DCI (OR = 2.24, 95% CI: 1.58–3.17) and unfavorable outcome (OR = 3.45, 95% CI: 1.95–6.07). In our validation cohort, 84 subjects showed similar predictive power of SEBES for a prediction of DCI and unfavorable long-term outcome. CONCLUSION SEBES may be a surrogate marker of EBI and predicts DCI and clinical outcomes after SAH.