Abdel Kaleel, MD, MSc

de Oliveira Manoel AL, Jaja BN, Germans MR, Yan H, Qian W, Kouzmina E, et al.The VASOGRADE: A Simple Grading Scale for Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage. Stroke. 2015

VASOGRADE, a grading scale mostly derived from the WFNS grade and modified Fisher scale, has been proposed for risk stratification after aneurysmal subarachnoid hemorrhage. The purpose of this study was to validate this scale, particularly its relationship with the development of Delayed Cerebral Ischemia (DCI). Consecutive patients between January 2012 and June 2013 at the St. Michael’s Hospital in Toronto, Canada were assessed, having been divided into three VASOGRADE categories: VASOGRADE-Green (modified Fisher scale 1 or 2 and World Federation of Neurosurgical Societies scale (WFNS) 1 or 2); VASOGRADE-Yellow (modified Fisher 3 or 4 and WFNS 1-3); and VASOGRADE-Red (WFNS 4 or 5, irrespective of modified Fisher grade. A total of 746 patients were included in the final analysis. The primary outcome was delayed cerebral ischemia (DCI). DCI was present in 151 patients with 15%, 9%, and 37% of VASOGRADES Green, Yellow, and Red groups having developed DCI, respectively. Patients who were identified as VASOGRADE Red had a significantly higher risk of development of DCI and patients who were classified as VASOGRADE Yellow had a tendency for a higher risk for DCI. Overall, DCI status was appropriately identified in almost 70% of patients. Multiple clinical applications of VASOGRADE’s use in DCI were proposed, including decision on disposition/length of stay and treatment aggressiveness, in addition to its ability to predict DCI risk.