Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a severe neurological emergency associated with high rates of mortality and disability. While multiple prognostic scores have been developed in high-income countries, evidence from low- and middle-income settings remains limited. Objective: To evaluate the predictive performance of clinical and radiological scores for mortality and functional outcomes in aSAH patients treated in a public tertiary center in a resource-limited country. Methods: We conducted a retrospective cohort study of adult patients with confirmed aSAH admitted between June 2018 and March 2022. Eight prognostic scores were applied: World Federation of Neurosurgical Societies (WFNS), Barrow Neurological Institute (BNI), VASOGRADE, Hunt and Hess score, Age, Intraventricular hemorrhage, and Rebleeding (HAIR), WFNS grade, Age, and Pupillary reactivity (WAP), Hemorrhage, Age, Treatment, Clinical Status, and Hydrocephalus (HATCH), Brain Aneurysm Institute (BAI), and modified BNI score. Primary outcomes were in-hospital mortality and poor functional outcome (modified Rankin Scale 4-6) at 90 days. Discriminative ability was assessed using the area under the receiver operating characteristic curve (AUROC) and bootstrap comparisons. Results: Among 74 patients, in-hospital mortality was 42%, and 68.9% had poor functional outcomes. All scores demonstrated good predictive performance (AUROC ≥ 0.78). The mBNI and WFNS had the highest AUROCs for functional outcome (0.88 and 0.86, respectively), with mBNI significantly outperforming BNI (difference = 0.16; 95% CI: 0.085-0.25). The HATCH score showed moderate accuracy (AUROC 0.79), although significantly inferior to mBNI in pairwise comparison. There were no missing data, and scores were not used to guide clinical care. Conclusion: Despite being developed in high-income countries, the selected prognostic scores showed strong performance in a resource-limited setting. These results support their use as early risk stratification tools and emphasize the need for further validation in middle-income healthcare systems.
Marazzi et al. (Wed,) studied this question.