Prediction of Symptomatic Vasospasmafter Subarachnoid Hemorrhage: The Modified Fisher Scale
Top Cited Papers
- 1 July 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 59 (1), 21-27
- https://doi.org/10.1227/01.neu.0000218821.34014.1b
Abstract
We developed a modification of the Fisher computed tomographic rating scale and compared it with the original Fisher scale to determine which scale best predicts symptomatic vasospasm after subarachnoid hemorrhage. We analyzed data from 1355 subarachnoid hemorrhage patients in the placebo arm of four randomized, double-blind, placebo-controlled studies of tirilazad. Modified Fisher computed tomographic grades were calculated on the basis of the presence of cisternal blood and intraventricular hemorrhage. Crude odds ratios (OR) reflecting the risk of developing symptomatic vasospasm were calculated for each scale level, and adjusted ORs expressing the incremental risk were calculated after controlling for known predictors of vasospasm. Of 1355 patients, 451 (33%) developed symptomatic vasospasm. For the modified Fisher scale, compared with Grade 0 to 1 patients, the crude OR for vasospasm was 1.6 (95% confidence interval [CI], 1.0-2.5) for Grade 2, 1.6 (95% CI, 1.1-2.2) for Grade 3, and 2.2 (95% CI, 1.6-3.1) for Grade 4. For the original Fisher scale, referenced to Grade 1, the OR for vasospasm was 1.3 (95% CI, 0.7-2.2) for Grade 2, 2.2 (95% CI, 1.4-3.5) for Grade 3, and 1.7 (95% CI, 1.0-3.0) for Grade 4. Early angiographic vasospasm, history of hypertension, neurological grade, and elevated admission mean arterial pressure were identified as risk factors for symptomatic vasospasm. After adjusting for these variables, the modified Fisher scale remained a significant predictor of vasospasm (adjusted OR, 1.28; 95% CI, 1.06-1.54), whereas the original Fisher scale was not. The modified Fisher scale, which accounts for thick cisternal and ventricular blood, predicts symptomatic vasospasm after subarachnoid hemorrhage more accurately than original Fisher scale.Keywords
This publication has 29 references indexed in Scilit:
- Early Vasospasm on Admission Angiography in Patients with Aneurysmal Subarachnoid Hemorrhage Is a Predictor for In-Hospital Complications and Poor OutcomeStroke, 2004
- Cocaine use as a predictor of outcome in aneurysmal subarachnoid hemorrhageJournal of Neurosurgery, 2003
- Effect of Cisternal and Ventricular Blood on Risk of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage:Stroke, 2001
- Initial Loss of Consciousness and Risk of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid HemorrhageStroke, 1999
- Multivariate Analysis of Predictors of Cerebral Vasospasm Occurrence After Aneurysmal Subarachnoid HemorrhageStroke, 1999
- A randomized, double-blind, vehicle-controlled trial of tirilazad mesylate in patients with aneurysmal subarachnoid hemorrhage: a cooperative study in North AmericaJournal of Neurosurgery, 1997
- Amount of blood on computed tomography as an independent predictor after aneurysm rupture.Stroke, 1993
- Prediction of delayed cerebral ischemia, rebleeding, and outcome after aneurysmal subarachnoid hemorrhage.Stroke, 1988
- The value of computerized tomography in aneurysmal subarachnoid hemorrhageJournal of Neurosurgery, 1984
- Relation of Cerebral Vasospasm to Subarachnoid Hemorrhage Visualized by Computerized Tomographic ScanningNeurosurgery, 1980