Key result
Novel multivariable clinical model shows moderate discrimination for 2-month mRS, yielding a 0.65 c-statistic.
Why the study?
A prognostic model to predict ordinal clinical outcome at two months after aneurysmal subarachnoid haemorrhage was lacking to support clinical decision making.
Observational (n=2,128)
Yes
Effect estimate: c statistic 0.65
Moderate discrimination limits reliable individual prognostication; extends standard-variable models but leaves open need for stronger predictors.
BACKGROUND: Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. METHODS: We studied patients enrolled in the International Subarachnoid Aneurysm Trial (ISAT), a randomized multicentre trial to compare coiling and clipping in aSAH patients.Several models were explored to estimate a patient's outcome according to the modified Rankin Scale (mRS) at two months after aSAH. Our final model was validated internally with bootstrapping techniques. RESULTS: The study population comprised of 2,128 patients of whom 159 patients died within 2 months (8%). Multivariable proportional odds analysis identified World Federation of Neurosurgical Societies (WFNS) grade as the most important predictor, followed by age, sex, lumen size of the aneurysm, Fisher grade, vasospasm on angiography, and treatment modality. The model discriminated moderately between those with poor and good mRS scores (c statistic = 0.65), with minor optimism according to bootstrap re-sampling (optimism corrected c statistic = 0.64). CONCLUSION: We presented a calibrated and internally validated ordinal prognostic model to predict two month mRS in aSAH patients who survived the early stage up till a treatment decision. Although generalizability of the model is limited due to the selected population in which it was developed, this model could eventually be used to support clinical decision making after external validation. TRIAL REGISTRATION: International Standard Randomised Controlled Trial, Number ISRCTN49866681.
No takes yet. Share an insight, caveat, or question.
Risselada et al. (2010) conducted an observational in Aneurysmal subarachnoid haemorrhage (aSAH) (n=2,128). Clinical and neuro-imaging predictors (WFNS grade, age, sex, lumen size, Fisher grade, vasospasm, treatment modality) was evaluated on Modified Rankin Scale (mRS) at two months (c statistic 0.65). A multivariable proportional odds model incorporating WFNS grade, age, sex, aneurysm lumen size, Fisher grade, vasospasm, and treatment modality discriminated moderately between poor and good 2-month mRS scores with a c-statistic of 0.65.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: