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Prognostic Score of Jagger et al for a Patient with Subarachnoid Hemorrhage

Purpose: To evaluate a patient with a subarachnoid hemorrhage using the prognostic score of Jagger et al.

Description

Jagger et al used the sum of eye and motor responses to evaluate a patient with subarachnoid hemorrhage. This can help to identify a patient who may require more aggressive management. The authors are from the University of Virginia in Charlottesville.


NOTE: The parameters are similar to the Glasgow Coma Score without a verbal response component.

 

Parameters:

(1) eye opening response

(2) motor responses

(3) secondary complications (pneumonia, etc)

 

Parameter

Finding

Points

eye opening response

spontaneous

4

 

after verbal stimulation

3

 

only with painful stimuli

2

 

absent despite maximal stimuli

1

motor response

normal

4

 

mild, focal deficit

3

 

severe, focal deficit

2

 

abnormal extensor or flexor posturing (severe global deficit)

1

 

none even after painful stimuli; flaccid muscles

1

 

where:

• The descriptions for eye opening response in Table 1(page 328) include none eye observations: 4 = immediate response to verbal stimulus; 3 = slightly impaired consciousness; 2 = incomplete arousal and reverts to prestimulus state when stimulus removed; 1 = does not speak with intelligible words.

 

total score =

= (points for eye opening response) + (points for motor response)

 

Interpretation:

• minimal score: 2

• maximal score: 8

• A score of 8 is normal while a score of 2 is associated with a moribund state.

• The rate of mortality at 6 months progressively increases as the score decreases. The presence of secondary complications increases mortality up to 20% compared to someone without complications.

• The rate of good recovery at 6 months progressively decreases as the score decreases. Secondary complications may significantly decrease the rate of recovery as well.

• Prevention of secondary complications can significantly improve outcome.


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Specialty

Objective

ICD-10