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Clinical Neuroradiology
Published in: Clinical Neuroradiology 3/2017

01-09-2017 | Original Article

The Hijdra scale has significant prognostic value for the functional outcome of Fisher grade 3 patients with subarachnoid hemorrhage

Authors: Julia S. Bretz, Falk Von Dincklage, MD, Johannes Woitzik, MD, Maren K. L. Winkler, MD, Sebastian Major, MD, Jens P. Dreier, MD Phd, Georg Bohner, MD, Michael Scheel, MD

Published in: Clinical Neuroradiology | Issue 3/2017

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Abstract

Purpose

Despite its high prevalence among patients with aneurysmal subarachnoid hemorrhage (aSAH) and high risk of delayed cerebral ischemia (DCI), the Fisher grade 3 category remains a poorly studied subgroup. The aim of this cohort study has been to investigate the prognostic value of the Hijdra sum scoring system for the functional outcome in patients with Fisher grade 3 aSAH, in order to improve the risk stratification within this Fisher category.

Methods

Initial CT scans of 72 prospectively enrolled patients with Fisher grade 3 aSAH were analyzed, and cisternal, ventricular, and total amount of blood were graded according to the Hijdra scale. Additionally, space-occupying subarachnoid blood clots were assessed. Outcome was evaluated after 6 months.

Results

Within the subgroup of Fisher grade 3, aSAH patients with an unfavorable outcome showed a significantly larger cisternal Hijdra sum score (HSS: 21.1 ± 5.2) than patients with a favorable outcome (HSS: 17.6 ± 5.9; p = 0.009). However, both the amount of ventricular blood (p = 0.165) and space-occupying blood clots (p = 0.206) appeared to have no prognostic relevance. After adjusting for the patient’s age, gender, tobacco use, clinical status at admission, and presence of intracerebral hemorrhage, the cisternal and total HSS remained the only independent parameters included in multivariate logistic regression models to predict functional outcome (p < 0.01).

Conclusion

The cisternal Hijdra score is fairly easy to perform and the present study indicates that it has an additional predictive value for the functional outcome within the Fisher 3 category. We suggest that the Hijdra scale is a practically useful prognostic instrument for the risk evaluation after aSAH and should be applied more often in the clinical setting.
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Metadata
Title
The Hijdra scale has significant prognostic value for the functional outcome of Fisher grade 3 patients with subarachnoid hemorrhage
Authors
Julia S. Bretz
Falk Von Dincklage, MD
Johannes Woitzik, MD
Maren K. L. Winkler, MD
Sebastian Major, MD
Jens P. Dreier, MD Phd
Georg Bohner, MD
Michael Scheel, MD
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 3/2017
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-016-0509-0

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