. 2018 Jan 18:360:j5745.

doi: 10.1136/bmj.j5745.

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

Blessing N R Jaja^{1

2

3}, Gustavo Saposnik^{4

2

3}, Hester F Lingsma⁵, Erin Macdonald², Kevin E Thorpe⁶, Muhammed Mamdani^{3

6}, Ewout W Steyerberg^{5

7}, Andrew Molyneux⁸, Airton Leonardo de Oliveira Manoel^{1

2}, Bawarjan Schatlo⁹, Daniel Hanggi¹⁰, David Hasan¹¹, George K C Wong¹², Nima Etminan¹⁰, Hitoshi Fukuda¹³, James Torner¹⁴, Karl L Schaller¹⁵, Jose I Suarez¹⁶, Martin N Stienen¹⁷, Mervyn D I Vergouwen¹⁸, Gabriel J E Rinkel¹⁸, Julian Spears^{1

19}, Michael D Cusimano^{1

3

19}, Michael Todd²⁰, Peter Le Roux²¹, Peter Kirkpatrick²², John Pickard²², Walter M van den Bergh²³, Gordon Murray²⁴, S Claiborne Johnston²⁵, Sen Yamagata¹³, Stephan Mayer²⁶, Tom A Schweizer^{1

2

3

19}, R Loch Macdonald^{1

2

3

19}; SAHIT collaboration

Affiliations

¹ Division of Neurosurgery, St Michael's Hospital, Toronto, ON, Canada.
² Neuroscience Research Program of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
³ Institute of Medical Science, University of Toronto, ON, Canada.
⁴ Division of Neurology, St Michael's Hospital, Toronto, ON, Canada.
⁵ Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, Netherlands.
⁶ Department of Health Policy, Management and Evaluation, University of Toronto, ON, Canada.
⁷ Department of Medical Statistics, Leiden University Medical Centre, Leiden, Netherlands.
⁸ Division of Endovascular Neurosurgery, Department of Neurosurgery, University of Oxford, Oxford, UK.
⁹ Department of Neurosurgery, University Hospital Göttingen, Germany.
¹⁰ Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg Theodor-Kutzer-Ufer 1-3, Germany.
¹¹ Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
¹² Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
¹³ Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-city, Okayama, Japan.
¹⁴ Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.
¹⁵ Department of Clinical Neurosciences, Hôpitaux, Universitaire de Genève, Geneva, Switzerland.
¹⁶ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
¹⁷ Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland.
¹⁸ Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, room G03-228, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
¹⁹ Department of Surgery, University of Toronto, ON, Canada.
²⁰ Department of Anesthesia, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.
²¹ The Brain and Spine Center, Lankenau Medical Center, Wynnewood, PA, USA.
²² Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK.
²³ Department of Critical Care, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
²⁴ Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
²⁵ Dell School of Medicine, University of Texas, Austin, TX, USA.
²⁶ Division of Critical Care Neurology, Columbia University College of Physicians and Surgeons, New York, USA.

PMID: 29348138
DOI: 10.1136/bmj.j5745

Free article

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

Blessing N R Jaja et al. BMJ. 2018.

Free article

. 2018 Jan 18:360:j5745.

doi: 10.1136/bmj.j5745.

Authors

Affiliations

¹ Division of Neurosurgery, St Michael's Hospital, Toronto, ON, Canada.
² Neuroscience Research Program of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
³ Institute of Medical Science, University of Toronto, ON, Canada.
⁴ Division of Neurology, St Michael's Hospital, Toronto, ON, Canada.
⁵ Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, Netherlands.
⁶ Department of Health Policy, Management and Evaluation, University of Toronto, ON, Canada.
⁷ Department of Medical Statistics, Leiden University Medical Centre, Leiden, Netherlands.
⁸ Division of Endovascular Neurosurgery, Department of Neurosurgery, University of Oxford, Oxford, UK.
⁹ Department of Neurosurgery, University Hospital Göttingen, Germany.
¹⁰ Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg Theodor-Kutzer-Ufer 1-3, Germany.
¹¹ Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
¹² Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
¹³ Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-city, Okayama, Japan.
¹⁴ Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.
¹⁵ Department of Clinical Neurosciences, Hôpitaux, Universitaire de Genève, Geneva, Switzerland.
¹⁶ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
¹⁷ Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland.
¹⁸ Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, room G03-228, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
¹⁹ Department of Surgery, University of Toronto, ON, Canada.
²⁰ Department of Anesthesia, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.
²¹ The Brain and Spine Center, Lankenau Medical Center, Wynnewood, PA, USA.
²² Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK.
²³ Department of Critical Care, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
²⁴ Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
²⁵ Dell School of Medicine, University of Texas, Austin, TX, USA.
²⁶ Division of Critical Care Neurology, Columbia University College of Physicians and Surgeons, New York, USA.

PMID: 29348138
DOI: 10.1136/bmj.j5745

Erratum in

Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study.
[No authors listed] [No authors listed] BMJ. 2018 Sep 26;362:k4079. doi: 10.1136/bmj.k4079. BMJ. 2018. PMID: 30257825 Free PMC article. No abstract available.

Abstract

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.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; RLM receives grant support from the Physicians Services Incorporated Foundation, Brain Aneurysm Foundation, Canadian Institutes for Health Research, and the Heart and Stroke Foundation of Canada and is chief scientific officer of Edge Therapeutics; GS is supported by the distinguished clinician scientist award from Heart and Stroke Foundation of Canada (HSFC); SM is a consultant to Actelion Pharmaceuticals; PLeR is a member of the scientific advisory board of Edge Therapeutics and Cerebrotech and provides regular consultation for Integra LifeSciences, Depuy-Synthes, Codman, and Neurologica; no other relationships or activities that could appear to have influenced the submitted work.

Comment in

Predicting outcomes in aneurysmal subarachnoid haemorrhage.
Nath S, Koziarz A, Badhiwala JH, Almenawer SA. Nath S, et al. BMJ. 2018 Jan 24;360:k102. doi: 10.1136/bmj.k102. BMJ. 2018. PMID: 29367205 No abstract available.

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

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

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Affiliations

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Conflict of interest statement

Comment in

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