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Published in: Neurocritical Care 1/2019

01-06-2019 | Subarachnoid Hemorrhage | Special Article

Common Data Element for Unruptured Intracranial Aneurysm and Subarachnoid Hemorrhage: Recommendations from Assessments and Clinical Examination Workgroup/Subcommittee

Authors: Rahul Damani, Stephan Mayer, Raj Dhar, Renee H. Martin, Paul Nyquist, DaiWai M. Olson, Jorge H. Mejia-Mantilla, Susanne Muehlschlegel, Edward C. Jauch, J. Mocco, Tatsushi Mutoh, Jose I. Suarez, the Unruptured Intracranial Aneurysms and SAH CDE Project Investigators

Published in: Neurocritical Care | Special Issue 1/2019

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Abstract

Background

Clinical studies of subarachnoid hemorrhage (SAH) and unruptured cerebral aneurysms lack uniformity in terms of variables used for assessments and clinical examination of patients which has led to difficulty in comparing studies and performing meta-analyses. The overall goal of the National Institute of Health/National Institute of Neurological Disorders and Stroke Unruptured Intracranial Aneurysms (UIA) and subarachnoid hemorrhage (SAH) Common Data Elements (CDE) Project was to provide common definitions and terminology for future unruptured intracranial aneurysm and SAH research.

Methods

This paper summarizes the recommendations of the subcommittee on SAH Assessments and Clinical Examination. The subcommittee consisted of an international and multidisciplinary panel of experts in UIA and SAH. Consensus recommendations were developed by reviewing previously published CDEs for other neurological diseases including traumatic brain injury, epilepsy and stroke, and the SAH literature. Recommendations for CDEs were classified by priority into “core,” “supplemental—highly recommended,” “supplemental” and “exploratory.”

Results

We identified 248 variables for Assessments and Clinical Examination. Only the World Federation of Neurological Societies grading scale was classified as “Core.” The Glasgow Coma Scale was classified as “Supplemental—Highly Recommended.” All other Assessments and Clinical Examination variables were categorized as “Supplemental.”

Conclusion

The recommended Assessments and Clinical Examination variables have been collated from a large number of potentially useful scales, history, clinical presentation, laboratory, and other tests. We hope that adherence to these recommendations will facilitate the comparison of results across studies and meta-analyses of individual patient data.
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Literature
1.
go back to reference Lovelock CE, Rinkel GJ, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review. Neurology. 2010;74(19):1494–501.CrossRef Lovelock CE, Rinkel GJ, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review. Neurology. 2010;74(19):1494–501.CrossRef
2.
go back to reference Maas AI, et al. Standardizing data collection in traumatic brain injury. J Neurotrauma. 2011;28(2):177–87.CrossRef Maas AI, et al. Standardizing data collection in traumatic brain injury. J Neurotrauma. 2011;28(2):177–87.CrossRef
3.
go back to reference Loring DW, et al. Common data elements in epilepsy research: development and implementation of the NINDS epilepsy CDE project. Epilepsia. 2011;52(6):1186–91.CrossRef Loring DW, et al. Common data elements in epilepsy research: development and implementation of the NINDS epilepsy CDE project. Epilepsia. 2011;52(6):1186–91.CrossRef
4.
go back to reference Saver JL, et al. Standardizing the structure of stroke clinical and epidemiologic research data: the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Common Data Element (CDE) project. Stroke. 2012;43(4):967–73.CrossRef Saver JL, et al. Standardizing the structure of stroke clinical and epidemiologic research data: the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Common Data Element (CDE) project. Stroke. 2012;43(4):967–73.CrossRef
5.
go back to reference Dorhout Mees SM, et al. Magnesium for aneurysmal subarachnoid haemorrhage (MASH-2): a randomised placebo-controlled trial. Lancet. 2012;380(9836):44–9.CrossRef Dorhout Mees SM, et al. Magnesium for aneurysmal subarachnoid haemorrhage (MASH-2): a randomised placebo-controlled trial. Lancet. 2012;380(9836):44–9.CrossRef
6.
go back to reference Kirkpatrick PJ, et al. Simvastatin in aneurysmal subarachnoid haemorrhage (STASH): a multicentre randomised phase 3 trial. Lancet Neurol. 2014;13(7):666–75.CrossRef Kirkpatrick PJ, et al. Simvastatin in aneurysmal subarachnoid haemorrhage (STASH): a multicentre randomised phase 3 trial. Lancet Neurol. 2014;13(7):666–75.CrossRef
7.
go back to reference Siironen J, et al. No effect of enoxaparin on outcome of aneurysmal subarachnoid hemorrhage: a randomized, double-blind, placebo-controlled clinical trial. J Neurosurg. 2003;99(6):953–9.CrossRef Siironen J, et al. No effect of enoxaparin on outcome of aneurysmal subarachnoid hemorrhage: a randomized, double-blind, placebo-controlled clinical trial. J Neurosurg. 2003;99(6):953–9.CrossRef
8.
go back to reference Molyneux A, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360(9342):1267–74.CrossRef Molyneux A, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002;360(9342):1267–74.CrossRef
9.
go back to reference van Gijn J, et al. Definition of initial grading, specific events, and overall outcome in patients with aneurysmal subarachnoid hemorrhage. A survey. Stroke. 1994;25(8):1623–7.CrossRef van Gijn J, et al. Definition of initial grading, specific events, and overall outcome in patients with aneurysmal subarachnoid hemorrhage. A survey. Stroke. 1994;25(8):1623–7.CrossRef
10.
go back to reference Drake CG. Report of world federation of neurological surgeons committee on a universal subarachnoid hemorrhage grading scale. J Neurosurg. 1988;68(6):985–6. Drake CG. Report of world federation of neurological surgeons committee on a universal subarachnoid hemorrhage grading scale. J Neurosurg. 1988;68(6):985–6.
11.
go back to reference Rosen DS, Macdonald RL. Subarachnoid hemorrhage grading scales: a systematic review. Neurocrit Care. 2005;2(2):110–8.CrossRef Rosen DS, Macdonald RL. Subarachnoid hemorrhage grading scales: a systematic review. Neurocrit Care. 2005;2(2):110–8.CrossRef
12.
go back to reference Jaja BN, et al. Clinical prediction models for aneurysmal subarachnoid hemorrhage: a systematic review. Neurocrit Care. 2013;18(1):143–53.CrossRef Jaja BN, et al. Clinical prediction models for aneurysmal subarachnoid hemorrhage: a systematic review. Neurocrit Care. 2013;18(1):143–53.CrossRef
13.
go back to reference Jaja BNR, et al. Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study. BMJ. 2018;360:j5745.CrossRef Jaja BNR, et al. Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study. BMJ. 2018;360:j5745.CrossRef
14.
go back to reference Degen LA, et al. Interobserver variability of grading scales for aneurysmal subarachnoid hemorrhage. Stroke. 2011;42(6):1546–9.CrossRef Degen LA, et al. Interobserver variability of grading scales for aneurysmal subarachnoid hemorrhage. Stroke. 2011;42(6):1546–9.CrossRef
15.
go back to reference Pal J, Brown R, Fleiszer D. The value of the Glasgow Coma Scale and Injury Severity Score: predicting outcome in multiple trauma patients with head injury. J Trauma. 1989;29(6):746–8.CrossRef Pal J, Brown R, Fleiszer D. The value of the Glasgow Coma Scale and Injury Severity Score: predicting outcome in multiple trauma patients with head injury. J Trauma. 1989;29(6):746–8.CrossRef
16.
go back to reference Rocca B, et al. Comparison of four severity scores in patients with head trauma. J Trauma. 1989;29(3):299–305.CrossRef Rocca B, et al. Comparison of four severity scores in patients with head trauma. J Trauma. 1989;29(3):299–305.CrossRef
17.
go back to reference Kennedy F, et al. The Glasgow Coma Scale and prognosis in gunshot wounds to the brain. J Trauma. 1993;35(1):75–7.CrossRef Kennedy F, et al. The Glasgow Coma Scale and prognosis in gunshot wounds to the brain. J Trauma. 1993;35(1):75–7.CrossRef
18.
go back to reference Polin RS, et al. Multivariate analysis and prediction of outcome following penetrating head injury. Neurosurg Clin N Am. 1995;6(4):689–99.CrossRef Polin RS, et al. Multivariate analysis and prediction of outcome following penetrating head injury. Neurosurg Clin N Am. 1995;6(4):689–99.CrossRef
19.
go back to reference Mase G, et al. Immediate prognosis of primary intracerebral hemorrhage using an easy model for the prediction of survival. Acta Neurol Scand. 1995;91(4):306–9.CrossRef Mase G, et al. Immediate prognosis of primary intracerebral hemorrhage using an easy model for the prediction of survival. Acta Neurol Scand. 1995;91(4):306–9.CrossRef
20.
go back to reference Gotoh O, et al. Glasgow Coma Scale in the prediction of outcome after early aneurysm surgery. Neurosurgery. 1996;39(1):19–24 (Discussion 24–5).CrossRef Gotoh O, et al. Glasgow Coma Scale in the prediction of outcome after early aneurysm surgery. Neurosurgery. 1996;39(1):19–24 (Discussion 24–5).CrossRef
21.
go back to reference Oshiro EM, et al. A new subarachnoid hemorrhage grading system based on the Glasgow Coma Scale: a comparison with the Hunt and Hess and World Federation of Neurological Surgeons Scales in a clinical series. Neurosurgery. 1997;41(1):140–7 (Discussion 147–8).CrossRef Oshiro EM, et al. A new subarachnoid hemorrhage grading system based on the Glasgow Coma Scale: a comparison with the Hunt and Hess and World Federation of Neurological Surgeons Scales in a clinical series. Neurosurgery. 1997;41(1):140–7 (Discussion 147–8).CrossRef
22.
go back to reference Menegazzi JJ, et al. Reliability of the Glasgow Coma Scale when used by emergency physicians and paramedics. J Trauma. 1993;34(1):46–8.CrossRef Menegazzi JJ, et al. Reliability of the Glasgow Coma Scale when used by emergency physicians and paramedics. J Trauma. 1993;34(1):46–8.CrossRef
23.
go back to reference Teasdale G, Knill-Jones R, van der Sande J. Observer variability in assessing impaired consciousness and coma. J Neurol Neurosurg Psychiatry. 1978;41(7):603–10.CrossRef Teasdale G, Knill-Jones R, van der Sande J. Observer variability in assessing impaired consciousness and coma. J Neurol Neurosurg Psychiatry. 1978;41(7):603–10.CrossRef
24.
go back to reference Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28(1):14–20.CrossRef Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28(1):14–20.CrossRef
25.
go back to reference Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6(1):1–9.CrossRef Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6(1):1–9.CrossRef
26.
go back to reference Fujita S. Computed tomographic grading with Hounsfield number related to delayed vasospasm in cases of ruptured cerebral aneurysm. Neurosurgery. 1985;17(4):609–12.CrossRef Fujita S. Computed tomographic grading with Hounsfield number related to delayed vasospasm in cases of ruptured cerebral aneurysm. Neurosurgery. 1985;17(4):609–12.CrossRef
27.
go back to reference Claassen J, et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke. 2001;32(9):2012–20.CrossRef Claassen J, et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke. 2001;32(9):2012–20.CrossRef
28.
go back to reference Ogilvy CS, Carter BS. A proposed comprehensive grading system to predict outcome for surgical management of intracranial aneurysms. Neurosurgery. 1998;42(5):959–68 (Discussion 968–70).CrossRef Ogilvy CS, Carter BS. A proposed comprehensive grading system to predict outcome for surgical management of intracranial aneurysms. Neurosurgery. 1998;42(5):959–68 (Discussion 968–70).CrossRef
29.
go back to reference Wiebers DO, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103–10.CrossRef Wiebers DO, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103–10.CrossRef
30.
go back to reference Rosengart AJ, et al. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38(8):2315–21.CrossRef Rosengart AJ, et al. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38(8):2315–21.CrossRef
31.
go back to reference Galea JP, et al. Predictors of outcome in aneurysmal subarachnoid hemorrhage patients: observations from a multicenter data set. Stroke. 2017;48(11):2958–63.CrossRef Galea JP, et al. Predictors of outcome in aneurysmal subarachnoid hemorrhage patients: observations from a multicenter data set. Stroke. 2017;48(11):2958–63.CrossRef
32.
go back to reference Suarez JI, Sheikh MK, Macdonald RL, Amin-Hanjani S, Brown RD Jr, de Oliveira Manoel AL, Derdeyn C, Etminan N, Keller E, Leroux PD, Mayer SA, Morita A, Rinkel G, Rufennacht D, Stienen, M, Torner J, Vergouwen, MD, Wong GKC, on behalf of the Unruptured Cerebral Aneurysms and SAH CDE Project Investigators. Common data elements for unruptured cerebral aneurysms and subarachnoid hemorrhage clinical research: a National Institute for Neurological Disorders and Stroke, National Library of Medicine, and Neurocritical Care Society Project. Neurocritical Care 2019. Suarez JI, Sheikh MK, Macdonald RL, Amin-Hanjani S, Brown RD Jr, de Oliveira Manoel AL, Derdeyn C, Etminan N, Keller E, Leroux PD, Mayer SA, Morita A, Rinkel G, Rufennacht D, Stienen, M, Torner J, Vergouwen, MD, Wong GKC, on behalf of the Unruptured Cerebral Aneurysms and SAH CDE Project Investigators. Common data elements for unruptured cerebral aneurysms and subarachnoid hemorrhage clinical research: a National Institute for Neurological Disorders and Stroke, National Library of Medicine, and Neurocritical Care Society Project. Neurocritical Care 2019.
Metadata
Title
Common Data Element for Unruptured Intracranial Aneurysm and Subarachnoid Hemorrhage: Recommendations from Assessments and Clinical Examination Workgroup/Subcommittee
Authors
Rahul Damani
Stephan Mayer
Raj Dhar
Renee H. Martin
Paul Nyquist
DaiWai M. Olson
Jorge H. Mejia-Mantilla
Susanne Muehlschlegel
Edward C. Jauch
J. Mocco
Tatsushi Mutoh
Jose I. Suarez
the Unruptured Intracranial Aneurysms and SAH CDE Project Investigators
Publication date
01-06-2019
Publisher
Springer US
Published in
Neurocritical Care / Issue Special Issue 1/2019
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-019-00736-1

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