It is well known that Hunt and Kosnik grading in the patients of subarachnoid hemorrhage due to the ruptured aneurysm is fairly related to their outcome. This grading, however, does not include some important factors such as age of the patients, chronological stages, spreads of subarachnoid hemorrhage seen in the CT scan, severity of vasospasm, and so on. Then there have been some gaps between the grade and the outcome, especially in the grade III.
We performed re-evaluation of Hunt and Kosnik grading in concerning about the relationship between the initial grade and the outcome by using multiple variant analysis.
Case materials included 353 cases of ruptured aneurysm. Forty cases were classified into grade III. The outcome was divided into four groups, good, fair, poor, and died. The groups of good and fair were considered to be useful recovery.
In our results, the rates of useful recovery were 87.8% in grade I and II, 65.0% in grade III, and 12.8% in grade IV and V respectively. This results suggested that Hunt and Kosnik grading was useful to predict the prognosis of patients. However, it seemed to be necessary to classify grade III into more detail categories. Then, the factors listed in Table 1 were applied for re-evaluation.
The multiple variant analysis disclosed that following factors were selected to be discussed, which were age of the patients, level of consciousness at admission defined by using III-III-9 method of Japan, severity of subarachnoid hemorrhage seen in the CT scan, intracerebral hematomas, postoperative complication, and size of aneurysms.
In the further multiple variant analysis using the score of each factors, it was suggested that grade III could be divided into two groups.
In the patients, of grade III who have, at least, two of 3 following factors, age younger than 65, level of consciousness better than 3, and size of aneurysms smaller than 10mm in diameter, the rate of useful recovery was calculated to 80% or more.
From these analyses, we conclude that Hunt and Kosnik grading is useful for prediction of prognosis, but it is necessary to design new classification in grade III.
