Delayed cerebral ischemia after subarachnoid hemorrhage: Comparing and integrating classification systems

Subarachnoid hemorrhage (SAH) is a significant healthcare problem. It is estimated that 30000 Americans suffer from aneurysmal SAH each year. Delayed cerebral ischemia (DCI) is one of the major causes of morbidity and mortality after SAH, and occurs in 20–40% of patients.[4,5,8] To better predict and diagnose DCI after SAH, multiple grading scales have been published, of which the Fisher score is the most well‐known.[3] More recently, this score has been modified to predict symptomatic vasospasm after SAH more accurately.[4] Many other prediction models have been developed and published, and some of them use different parameters to calculate various outcomes that are associated with DCI and vasospasm.[1,2,7] Here, we present the SAH DCI app, which was developed to facilitate comparison between the various grading scales and to aid physicians in the use of prediction models. It incorporates automated calculation of a maximum of seven SAH grading scales, namely, the WFNS SAH grade, the Hunt and Hess grade, the original and modified Fisher grade, the early prediction scale by De Rooij et al., the BEHAVIOR score, and the VASOGRADE score.[1‐4,6,7,9] The WFNS SAH grade and the Hunt and Hess grade are general outcome predictors, and the other classification systems are specific predictors for DCI.