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Early Motor Glasgow Coma Scale Predicts Unfavorable Functional Outcome after Poor-Grade Subarachnoid Hemorrhage
Published online by Cambridge University Press: 24 July 2025
Abstract
Background:
We assessed whether the motor component of the Glasgow Coma Scale (GCSm) is independently associated with unfavorable outcomes in aggressively treated poor-grade subarachnoid hemorrhage (SAH) patients.
Methods:
Retrospective cohort of poor-grade SAH patients (World Federation of Neurosurgical Societies (WFNS) grades IV and V). The best GCSm score achieved within 24 h of admission was stratified into four categories (<4, 4, 5 or 6). Outcomes were classified as favorable [modified Rankin Scale (mRS) ≤ 2] or unfavorable (mRS ≥ 3). Multivariable logistic regression was performed to identify independent predictors of unfavorable outcome.
Results:
A total of 179 patients were admitted during the study period (mean age 55.9 ± 12.1; 68.2% female). Thirty-three patients (33/179 – 18%) died before aneurysm treatment, one patient had missing GCSm data at 24 h and sixteen patients (16/179; 9%) were lost to follow-up. One hundred and twenty-nine patients (129/179 – 72%) were included in the final analysis. No patient with GCSm < 4 had a favorable outcome (sensitivity 22.4%, specificity 100%, positive predictive value 100% and negative predictive value 67.8% for unfavorable outcome). Delayed cerebral ischemia-related cerebral infarction (odds ratio (OR) 4.06; 1.56−11.11 95% CI, p = 0.004) and the best GCSm score were independently associated with unfavorable outcome. There was a stepwise decrease in the rate of unfavorable outcome from GCSm < 4 to GCSm = 6 (<4 = 100%; 4 = 80%; 5 = 46% and 6 = 20%). Each one-point decrease in GCSm score was associated with an OR of 3.52 (1.77−7.92 95% CI, p = < 0.001) for unfavorable outcome.
Conclusion:
The GCSm score was independently associated with unfavorable outcome. All patients with a GCSm score < 4 experienced an unfavorable outcome.
Résumé
Évaluation motrice précoce sur l’échelle de Glasgow – Prévision de résultats fonctionnels défavorables après une hémorragie sous-arachnoïdienne très grave.
L’étude visait à évaluer s’il y avait une association indépendante entre la partie de l’évaluation motrice sur l’échelle de Glasgow (EG) et des résultats défavorables après une hémorragie sous-arachnoïdienne (HSA) très grave, traitée de manière intensive.
Il s’agit d’une étude de cohorte, rétrospective, composée de patients ayant subi une HSA très grave (degrés de gravité IV et V selon la Fédération mondiale des sociétés de neurochirurgie). Les meilleurs scores moteurs de Glasgow obtenus au cours des 24 heures suivant l’hospitalisation ont été divisés en quatre catégories (< 4, 4, 5, 6). Quant aux résultats, ils ont été scindés en deux classes : favorables (échelle de Rankin modifiée [ERM] : ≤ 2) et défavorables (EMR : ≥ 3). Enfin, les résultats défavorables indépendants ont été déterminés à l’aide d’une régression logistique plurifactorielle.
Au total, 179 patients ont été retenus au cours de l’étude (âge moyen : 55,9 ± 12,1 ans; femmes : 68,2 %). Sur ce nombre, 33 (33/179; 18 %) sont morts avant le traitement de l’anévrisme; 1 n’avait pas de données sur le score moteur de Glasgow au bout de 24 heures et 16 (16/179; 9 %) ont été perdus en cours de suivi, si bien qu’il restait 129 patients (129/179; 72 %) dans l’analyse finale. Aucun patient ayant obtenu un score moteur de Glasgow < 4 n’a présenté de résultats favorables (sensibilité : 22,4 %; spécificité : 100 %; valeur prévisionnelle positive [VPP] : 100 %; valeur prévisionnelle négative [VPN] : 67,8 % à l’égard des résultats défavorables). Les infarctus cérébraux liés à des lésions ischémiques cérébrales différées (risque relatif approché [RRA] : 4,06; IC à 95 % : 1,56 – 11,11; p = 0,004) et les meilleurs scores moteurs de Glasgow étaient associés de manière indépendante aux résultats défavorables. Une diminution graduelle en palier du taux de résultats défavorables a été observée en relation avec les scores moteurs de Glasgow : de < 4 à 6 (< 4 = 100 %; 4 = 80 %; 5 = 46 %; 6 = 20 %). Chaque perte de 1 point du score moteur de Glasgow était associée à un RRA de 3,52 (IC à 95 % : 1,77 – 7,92; p = < 0,001) de résultats défavorables.
Une association indépendante s’est établie, dans l’étude, entre les scores moteurs de Glasgow et les résultats défavorables. Tous les patients ayant obtenu un score moteur de Glasgow < 4 ont connu des résultats défavorables.
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