External Validation of the Modified Southwestern Aneurysm Severity Index in the Barrow Ruptured Aneurysm Trial Surgical Cohort

Authors

Mohamed A. Labib, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix , Arizona , USA.
Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix , Arizona , USA.
Mizuho Inoue, Department of Neurosurgery, University of Tokyo, Tokyo , Japan.
Kristina M. Kupanoff, Department of Trauma/Acute Care and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA.
Rohin Singh, Mayo Clinic Alix School of Medicine, Mayo Clinic, Phoenix , Arizona , USA.
Irakliy Abramov, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix , Arizona , USA.
Lea Scherschinski, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix , Arizona , USA.
Visish M. Srinivasan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix , Arizona , USA.
Teddy S. Youn, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix , Arizona , USA.
Robert F. Spetzler, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix , Arizona , USA.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix , Arizona , USA.

Document Type

Article

Abstract

BACKGROUND AND OBJECTIVES: Predicting functional outcomes after surgical management of ruptured aneurysms is essential. This study sought to validate the modified Southwestern Aneurysm Severity Index (mSASI), which predicts functional outcomes 1 year after treatment. METHODS: The surgical arm of a randomized controlled trial, the Barrow Ruptured Aneurysm Trial, was used to validate the mSASI model. mSASI scores incorporating the Hunt and Hess scale, Non-Neurological American Society of Anesthesiologists Physical Classification Status, imaging findings, and other modifiers were assigned and evaluated against the Glasgow Outcome Scale (GOS) score at 1 year. The model's performance was assessed for discrimination and calibration. Similar evaluations were constructed using the modified Rankin Scale (mRS) as the 1-year functional outcome measurement. Long-term outcomes (3, 6, 10 years) were also evaluated. RESULTS: Of 280 clinical trial patients treated surgically, 242 met the inclusion criteria. The mean age was 54.1 ± 12.9 years; 31% were men. Favorable GOS score (4-5) and mRS score (0-2) at 1 year were observed in 73.6% and 66.1% of patients, respectively. The mSASI model predicted unfavorable GOS score at 1 year with fair to good discrimination (area under the curve = 0.75, 95% CI = 0.68-0.82) and accurate calibration (R 2 = 0.98). Similar results were obtained when mRS was used as the outcome measure (area under the curve = 0.75, 95% CI = 0.68-0.82; R 2 = 0.95). CONCLUSION: The mSASI model was externally validated in our cohort to predict functional outcomes using the GOS or mRS scores 1 year after surgery. This index may be used for prognosticating outcomes of patients undergoing surgery for ruptured aneurysms at short-term and long-term intervals.

Medical Subject Headings

Humans; Male; Female; Middle Aged; Aneurysm, Ruptured (surgery); Aged; Severity of Illness Index; Adult; Intracranial Aneurysm (surgery, diagnostic imaging); Treatment Outcome; Cohort Studies; Glasgow Outcome Scale

Publication Date

9-1-2024

Publication Title

Neurosurgery

E-ISSN

1524-4040

Volume

95

Issue

3

First Page

660

Last Page

668

PubMed ID

38682903

Digital Object Identifier (DOI)

10.1227/neu.0000000000002959

Recommended Citation

Labib, Mohamed A.; Catapano, Joshua S.; Inoue, Mizuho; Kupanoff, Kristina M.; Singh, Rohin; Abramov, Irakliy; Scherschinski, Lea; Srinivasan, Visish M.; Youn, Teddy S.; Spetzler, Robert F.; and Lawton, Michael T., "External Validation of the Modified Southwestern Aneurysm Severity Index in the Barrow Ruptured Aneurysm Trial Surgical Cohort" (2024). Neurosurgery. 2000.
https://scholar.barrowneuro.org/neurosurgery/2000