クモ膜下出血の重症度分類

抄録

An old SAH grading system was formulated based on neurological finding, similar to Hunt's grading system. Recently, symptomatic vasospasm has been reported to be well correlated with amount of hematoma in the basal cistern as seen on CT. CT has become so popular now that almost every neurosurgical institute possesses a CT scanner. It is necessary to formulate a new SAH grading system which also includes CT findings.
239 cases of SAH were admitted to Fujita-Gakuen University Hospital from January 1982 to December 1984.
166 cases of SAH were made an object of this study. CT was taken within 48 hours after the onset and rebleeding did not occur in these cases.
SAH grading scale was formulated as below.
Age was classified into 3 groups as less than 54 year old…… 0 point. 55 to 69 year old 1 point. Over 70 year old…… 2 points.
Conscious level was classified as alert (JCS 0-1, GCS 15)…… 0 point. Somnolence (JCS 2-10, GCS 14-11)…… 1 point. Stupor (JCS 20-30, GCS 10-8)…… 2 points. Semicoma without brain stem sign (JCS 100, GCS 7-6)…… 3 points. Semicoma with brain stem sign(JCS 200, GCS 5-4)…… 4 points. Coma (JCS 300, GCS 3)…… 5 points. CT findings were classified as follow. SAH in the basal cistern was classified into 4 groups. No SAH…… 0 point. A little hematoma in the basal cistern…… 1 point, much hematoma in the basal cistern 2 points. Packed hematoma in the basal cistern…… 3 points.
ICH was classified into 3 groups. No hematoma…… 0 point. A small hematoma without midline shift…… 1 point. A large hematoma with midline shift…… 2 points.
All these factors were considered together for calculating SAH grading scale score. This SAH grading scale was well correlated to outcome. Y=0.855x+1.92 in cases of early operation. Y=0.843x-0.093 in other cases. Thus the outcome is statistically significantly better in early operated cases than that of delayed operated cases.