Classen et al reported a modified Fisher scale for grading the CT scan findings after a subarachnoid hemorrhage (SAH). This scale predicts symptomatic vasospasm better than the original scale. The authors are from Columbia University and the University of Chicago.
Patient selection: subarachnoid hemorrhage
Analysis: brain CT scan
Parameters:
(1) subarachnoid hemorrhage (SAH)
(2) intraventricular hemorrhage (IVH)
SAH
IVH
Modified Scale
Original Scale
thick, localized or diffuse
absent
3
3
present
4
3
thin, diffuse
absent
1
2
present
2
4
thin, localized
absent
1
1
present
2
4
none
absent
0
1
present
2
4
Modified Fisher Grade
Crude OR for Vasospasm
0 or 1
1
2 or 3
1.6
4
2.2
Additional risk factors for vasospasm:
(1) early vasospasm on angiography
(2) history of hypertension
(3) elevated mean arterial pressure on admission
(4) poor WFNS grade
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