Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study

Article Article scientifique Article Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study eng 2018 author Jaja Blessing N R author Saposnik Gustavo author Lingsma Hester F author Macdonald Erin author Thorpe Kevin E author Mamdani Muhammed author Steyerberg Ewout W author Molyneux Andrew author Manoel Airton Leonardo de Oliveira author Schatlo Bawarjan 673588 author Hanggi Daniel author Hasan David author Wong George K C author Etminan Nima author Fukuda Hitoshi 558014 author Torner James author Schaller Karl Lothard 658606 author Suarez Jose I author Stienen Martin N author Vergouwen Mervyn D I author Rinkel Gabriel J E author Spears Julian author Cusimano Michael D author Todd Michael author Le Roux Peter author Kirkpatrick Peter author Pickard John author van den Bergh Walter M author Murray Gordon author Johnston S Claiborne author Yamagata Sen author Mayer Stephan author Schweizer Tom A author Macdonald R Loch SAHIT collaboration collaborator Bijlenga Philippe Alexandre Pierre 0000-0002-3586-2757 104899 Département des neurosciences cliniques (OTONO) j5745 10.1136/bmj.j5745 29348138 0959-8138 https://www.bmj.com/content/360/bmj.j5745.long Objective: To develop and validate a set of practical prediction tools that reliably estimate the outcome of subarachnoid haemorrhage from ruptured intracranial aneurysms (SAH). Design: Cohort study with logistic regression analysis to combine predictors and treatment modality. Setting: Subarachnoid Haemorrhage International Trialists' (SAHIT) data repository, including randomised clinical trials, prospective observational studies, and hospital registries. Participants: Researchers collaborated to pool datasets of prospective observational studies, hospital registries, and randomised clinical trials of SAH from multiple geographical regions to develop and validate clinical prediction models. Main outcome measure: Predicted risk of mortality or functional outcome at three months according to score on the Glasgow outcome scale. Results: Clinical prediction models were developed with individual patient data from 10 936 patients and validated with data from 3355 patients after development of the model. In the validation cohort, a core model including patient age, premorbid hypertension, and neurological grade on admission to predict risk of functional outcome had good discrimination, with an area under the receiver operator characteristics curve (AUC) of 0.80 (95% confidence interval 0.78 to 0.82). When the core model was extended to a "neuroimaging model," with inclusion of clot volume, aneurysm size, and location, the AUC improved to 0.81 (0.79 to 0.84). A full model that extended the neuroimaging model by including treatment modality had AUC of 0.81 (0.79 to 0.83). Discrimination was lower for a similar set of models to predict risk of mortality (AUC for full model 0.76, 0.69 to 0.82). All models showed satisfactory calibration in the validation cohort. Conclusion: The prediction models reliably estimate the outcome of patients who were managed in various settings for ruptured intracranial aneurysms that caused subarachnoid haemorrhage. The predictor items are readily derived at hospital admission. The web based SAHIT prognostic calculator (http://sahitscore.com) and the related app could be adjunctive tools to support management of patients. Aneurysm, Ruptured / complications Cohort Studies Glasgow Outcome Scale Humans Intracranial Aneurysm / complications Observational Studies as Topic Patient Outcome Assessment Prognosis Prospective Studies Randomized Controlled Trials as Topic Registries Reproducibility of Results Risk Assessment / methods Subarachnoid Hemorrhage / etiology Subarachnoid Hemorrhage / mortality Dewey 616.8 61 Département des neurosciences cliniques 226 false 513 Groupe Schaller Karl Lothard (neurochirurgie) 851 BMJ 360 8137 99d17e94-8d3c-4043-b35e-1eeab95df3e6 Article (Published version) Public bmj.j5745.full.pdf 2194656 application/pdf CC BY-NC dc967144-40ae-4c6f-9924-105d3679fd47 Erratum Public bmj.k4079.full.pdf 636745 application/pdf CC BY-NC 2c07acdf-f0b2-4ce6-a064-e573e96fbfb6 Appendix Public jajb040049.ww1(1).pdf 379513 application/pdf CC BY-NC The authors of this paper (BMJ 2018;360:j5745, doi:10.1136/bmj.j5745) would like to acknowledge the contributions of researchers from the Swiss Study on Subarachnoid Haemorrhage (Swiss SOS): [names and affiliations of the researchers] 10.1136/bmj.k4079 30257825 openAccess Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques

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Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study	BMJ			2018	427	515

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Fukuda, Hitoshi