Objective
To evaluate the Fisher's Classification (FC) of aneurismal subarachnoid hemorrhage (SAH) as a predictor of cerebral vasospasm development.
Study design
A prospective database data analysis.
Inclusion criteria
Patients with SAH admitted from the 1st to the 12th day after bleeding.
Data analyzed
Age, sex, clinical grade according to WFNS classification, outcome according to Glasgow Outcome Scale (GOS), FC accomplished with the first computerised tomography scan, and vasospasm confirmed by angiography.
Statistical analysis
Positive predictive value, negative predictive value, sensitivity, specificity, likelihood ratio for a positive test result and likelihood ratio for a negative test result.
Results
From 1 October 1990 to 1 October 2001, 1090 patients were admitted to ENERI. Among these 443 completed the inclusion criteria. The mean age was 48 ± 13 years, 33% were male, 26% were in WFNS grade 1, 23% in grade 2, 24% in grade 3, 21% in grade 4 and 6% in grade 5. The outcome was: GOS 1: 9%, GOS 2: 1%, GOS 3: 6%, GOS 4: 9%, GOS 5: 74%. Among the aneurysms, 359 belong to the anterior circulation (AC) and 89 to the posterior circulation (PC). Regarding vasospasm, it was developed in 46% of the patients, 48% in the AC group and 40% in the PC group.
Conclusion
FC is not a good predictor of vasospasm development in SAH patients treated with endovascular procedures.
Table 1.
| Fisher data (spasm) | Our series (spasm) | |
|---|---|---|
| Fisher 1 | 0% | 28% |
| Fisher 2 | 9% | 41% |
| Fisher 3 | 95% | 51% |
| Fisher 4 | 23% | 50% |
Table 2.
| Positive predictive value | 37% |
|---|---|
| Negative predictive value | 59% |
| Sensitivity | 51% |
| Specificity | 56% |
| Likelihood ratio for a positive test | 0.84 |
| Likelihood ratio for a negative test | 0.87 |