Grading Scales for Subarachnoid Hemorrhage - Animal Models of Acute Neurological Injuries: Injury and Mechanistic Assessments - page 287

Biomarkers of brain injury are known to exist in the serum
after the brain has suffered an ischemic insult or injury. Naturally,
the utility of using these markers as a predictive guide after SAH
has been examined with some success. Some of the markers
currently under investigation include H-FABP, NDKA, UFD-1,
and S100 . Using the previously mentioned biomarkers with an

inclusion of a WFNS score and troponin I level ( 25 ) has shown to
be a relatively reliable predictor of three month GOS outcomes.
Further investigation is required before inclusion of the biomarker
scale in routine patient care.

β

9. Discussion

The value of an accurate prognostication scale is important across
all subspecialties of neurosurgery and prediction models exist in areas
ranging from traumatic brain injury to intracranial hemorrhage.
The ability to accurately predict outcomes in the SAH patient is of
great importance for both the patient and family. This information
allows the physician to triage patient care and to properly utilize
resources in a time, where all expenditures are under increased
scrutiny. An extended ICU course is routine as one observes for
subtle signs cerebral vasospasm. In our institution, a routine stay of
14 days even in the uncomplicated case is the typical course.
The clinical scales in common use today, such as the standard
WFNS; and Hunt and Hess do not adequately take into consider-
ation such valuable information as patient's age, associated medical
problems, and radiographic fi ndings. Oftentimes, these factors alone
are enough to preclude a patient from early treatment of a ruptured
intracranial aneurysm but are variables that are left out of the com-
monly used scales.
The ends of the outcome spectrum are seemingly easy to
predict and today it is expected that the neurologically well
SAH patient at admission should have a good outcome while the
systemically ill patient with poor GCS is equally expected to do
very poorly. It is those patients who fall somewhere in the middle
that would seemingly gain the most from an accurate prediction
model and any newly developed scale must make these patients a
priority in their studies.
The characteristics and goals for an SAH scale that avoids the
shortcomings of the scales in common use today have been addressed
( 17, 26 ) and a recent article ( 6 ) even went as far as to identify what
the perfect scale should include. Rosen et al. ( 6 ) in a recent review
of SAH grading scales provided four points that any new scale
should address (Table 6 ) and are discussed further below.
The perfect SAH predictive scale does not exist but continues
to be aggressively sought. Like most things in medicine no scale