Prognostication of long-term outcomes after subarachnoid hemorrhage: The FRESH-score

You can see for yourself that the telephone interview for cognitive status questions really have little objective correlation with where the damage is located.
The Rankin scale has no useful discrimination at all except for no. 6 - dead.
See page 3 and 4 here for Sickness Impact Profile questionnaire. Nothing objective about that since the patient is answering the questions.

Hunt & Hess Classification of Subarachnoid Hemorrhage doesn't look at anything objective at all except for the coma part and would they be able to tell the difference between coma and locked in?

 At least the apache ii acute physiology score seems to contain objective measurements.
No looking at all at 3d representations of the dead and damaged areas.  Does anyone have two neurons to rub together in stroke?
Do you really trust prediction scores based on this for your loved one?

Prognostication of long-term outcomes after subarachnoid hemorrhage: The FRESH-score

Witsch J¹, Frey HP¹, Patel S¹, Park S¹, Lahiri S¹, Schmidt JM¹, Agarwal S¹, Falo MC¹, Velazquez A¹, Jaja B², Macdonald RL², Connolly ES³, Claassen J¹.

Author information

Abstract

OBJECTIVE:

To create a multi-dimensional tool to prognosticate long-term functional, cognitive, and quality-of-life outcomes after spontaneous subarachnoid hemorrhage (SAH) using data up to 48 hours after admission.

METHODS:

Data were prospectively collected for 1619 consecutive patients enrolled in the SAH-outcome-project 07/1996-03/2014. Linear models (LM) were applied to identify factors associated with outcome in 1526 patients with complete data. 12-months functional, cognitive, and quality-of-life outcomes were measured using the Modified-Rankin-scale (mRS), Telephone-Interview-for-Cognitive-Status and the Sickness-Impact-Profile. Based on the LM-residuals, we constructed the FRESH-score (Functional Recovery Expected after Subarachnoid Hemorrhage). Score performance, discrimination and internal validity were tested using the area under the receiver-operating-characteristic-curve (AUC), Nagelkerke's and Cox/Snell's R-Squares, and bootstrapping. For external validation we used a control population of SAH-patients from the CONSCIOUS-1-study (n=413).

RESULTS:

The FRESH-score was composed of: Hunt&Hess and APACHE-II-physiologic scores on admission, age, and aneurysmal rebleed within 48 hours. Separate scores to prognosticate 1-year cognition (FRESH-cog) and quality-of-life (FRESH-quol) were developed controlling for education and premorbid disability. Poor functional outcome (mRS4-6) for score-levels 1 through 9 respectively was present in 3, 6, 12, 38, 61, 83, 92, 98 and 100% at 1-year-follow-up. Performance of FRESH (AUC 0.90), FRESH-cog (AUC 0.80) and FRESH-quol (AUC 0.78) was high. External validation of our cohort using mRS as endpoint showed satisfactory results (AUC 0.77). To allow for convenient score calculation we built a smartphone-app available for free download.

INTERPRETATION:

FRESH is the first clinical tool to prognosticate long-term outcome after spontaneous SAH in a multidimensional manner. This article is protected by copyright. All rights reserved.