• Stefan W Koester, Emmajane G Rhodenhiser, Stephen J Dabrowski, Lea Scherschinski, Joelle N Hartke, Anant Naik, Katherine Karahalios, Elsa Nico, Ashia M Hackett, Olga Ciobanu-Caraus, Laura Beatriz Lopez Lopez, Ethan A Winkler, Joshua S Catapano, and Michael T Lawton.
• Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
• World Neurosurg. 2024 Mar 1; 183: e447e453e447-e453.

ObjectiveThe PHASES (Population, Hypertension, Age, Size, Earlier subarachnoid hemorrhage, Site) score was developed to facilitate risk stratification for management of unruptured intracranial aneurysms (UIAs). This study aimed to identify the optimal PHASES score cutoff for predicting neurologic outcomes in patients with surgically treated aneurysms.MethodsAll patients who underwent microneurosurgical treatment for UIA at a large quaternary center from January 1, 2014, to December 31, 2020, were retrospectively reviewed. Inclusion criteria included a modified Rankin Scale (mRS) score of ≤2 at admission. The primary outcome was 1-year mRS score, with a "poor" neurologic outcome defined as an mRS score >2.ResultsIn total, 375 patients were included in the analysis. The mean (SD) PHASES score for the entire study population was 4.47 (2.67). Of 375 patients, 116 (31%) had a PHASES score ≥6, which was found to maximize prediction of poor neurologic outcome. Patients with PHASES scores ≥6 had significantly higher rates of poor neurologic outcome than patients with PHASES scores <6 at discharge (58 [50%] vs. 90 [35%], P = 0.005) and follow-up (20 [17%] vs. 18 [6.9%], P = 0.002). After adjusting for age, Charlson Comorbidity Index score, nonsaccular aneurysm, and aneurysm size, PHASES score ≥6 remained a significant predictor of poor neurologic outcome at follow-up (odds ratio, 2.75; 95% confidence interval, 1.42-5.36, P = 0.003).ConclusionsIn this retrospective analysis, a PHASES score ≥6 was associated with significantly greater proportions of poor outcome, suggesting that awareness of this threshold in PHASES scoring could be useful in risk stratification and UIA management.Copyright © 2023 Elsevier Inc. All rights reserved.

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