• Aditya M Mittal, Matthew Pease, David McCarthy, Andrew Legarreta, Raouf Belkhir, Elizabeth A Crago, Michael J Lang, and Bradley A Gross.
• Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: mittaladi@pitt.edu.
• World Neurosurg. 2023 Mar 1; 171: e874e878e874-e878.

BackgroundPatients with Hunt-Hess (HH)5 aneurysmal subarachnoid hemorrhage (SAH) have high mortality rates. Despite an initial moribund exam, a subset of patients progress to favorable outcomes.ObjectiveTo evaluate the utility of delayed HH grading to improve prognostication.MethodsWe retrospectively reviewed patients undergoing treatment of ruptured aneurysms at two level 1 stroke centers from January 2012 through December 2020. We collected relevant clinical information and developed a multivariate cox regression model to identify independent predictors of mortality. To evaluate the utility of delayed examinations in predicting outcomes, we re-assessed the HH grade at 48 hours post admission and constructed a logistic regression model with potential confounders to predict mortality.ResultsFrom 2012 to 2020, 621 patients underwent treatment for aneurysmal SAH. We identified 63 HH5 patients (10%) with a mean age of 58 years. Among these patients, the median length of stay was 14 days, with 3 patients passing away within 48 hours. The overall mortality rate was 63% at 24 months. To predict mortality, our cox regression model found only age to be significant (P = 0.002). Delayed HH grading improved prognostication at 48 hours and remained significant on multivariate analysis as a predictor of mortality (P = 0.0001). We observed a significant difference in mortality between patients HH5 and patients HH4 or lower at 48 hours (P = 0.0003).ConclusionsDelayed reassessment of HH grade 48 hours postadmission is a predictor of mortality, suggesting reassessment at 48 hours in high grade SAH leads to better prognostication.Copyright © 2023 Elsevier Inc. All rights reserved.

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