Exploring Clinical Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage and the Predictive Efficacy of Hijdra Sum Score—A Study at Bantane Hospital

Abstract

The Hijdra sum score (HSS) quantifies the burden of aneurysmal subarachnoid hemorrhage (aSAH) on initial computed tomography and demonstrates superior interobserver reliability compared with the Fisher and modified Fisher scales. This study evaluated clinical outcomes of patients with aSAH and assessed the predictive value of HSS.

A retrospective analysis was conducted on 23 patients with aSAH admitted to a tertiary care center between 2018 and 2023. Clinical outcomes evaluated included duration of intensive care unit (ICU) stay, risk of intracranial vasospasm, need for temporary cerebrospinal fluid (CSF) drainage, requirement for permanent shunt placement, and modified Rankin scale (mRS) scores at discharge and at 6-month follow-up. Associations between these outcomes and the HSS and Hunt and Hess (HH) grade were analyzed.

Considering the constrained patient cohort in this study, our analysis involved both statistical significance assessments based on p-values and a descriptive analysis.

Among the 23 patients, 1 (4.3%) died, and 20 (87.0%) achieved favorable functional outcomes (mRS 0–2) at 6 months. Clinically significant vasospasm occurred in one patient (4.3%). Temporary CSF drainage was required in 12 patients (52.2%), and permanent shunt placement in 7 patients (30.4%). The mean ICU stay was 13 days. A significant association was observed between HSS and the risk of intracranial vasospasm (p = 0.049). HH grade correlated significantly with ICU length of stay (p = 0.049) and mRS at 6 months (p = 0.044).

Radiographic prediction of risk of vasospasm with HSS is feasible. Further investigation is warranted to determine whether the development of a system integrating the quantitative burden of aSAH alongside clinical status could augment predictive capability for various negative outcomes other than mortality.