Von Donkelaar et al reported the SAFIRE grading scale to evaluate a patient with subarachnoid hemorrhage (SAH) associated with a ruptured intracranial aneurysm. The authors are from the University of Groningen, University of Oxford and Radcliff Hospitals NHS Trust.
SAFIRE is an acronym for the score components.
Patient selection: aneurysmal subarachnoid hemorrhage
Outcome: poor functional outcome at 2 months after SAH (modified Rankin scale 4, 5 or 6)
Parameters:
(1) size of the aneurysm in mm (S)
(2) age of the patient in years (A)
(3) Fisher grade (from 1 to 4, FI)
(4) resuscitated WFNS (World Federation of Neurologic Surgeons) grade (from 1 to 5, RE)
|
Parameter
|
Finding
|
Points
|
|
size of the aneurysm
|
< 10 mm
|
0
|
|
|
10 to 19.9 mm
|
2
|
|
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>= 20 mm
|
6
|
|
age of the patient
|
< 50 years
|
0
|
|
|
50 to 59.99 years
|
1
|
|
|
60 to 69.99
|
2
|
|
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>= 70 years
|
5
|
|
Fisher grade
|
1, 2 or 3
|
0
|
|
|
4
|
2
|
|
resuscitated WFNS grade
|
1
|
0
|
|
|
2
|
2
|
|
|
3
|
3
|
|
|
4
|
6
|
|
|
5
|
9
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 22
|
Score
|
Grade
|
Risk for Poor Outcome
|
Percent with Poor Outcome
|
|
<= 2
|
1
|
low
|
< 10%
|
|
3 to 5
|
2
|
low-intermediate
|
10 to 25%
|
|
6 to 8
|
3
|
intermediate
|
25 to 50%
|
|
9 to 15
|
4
|
intermediate-high
|
50 to 90%
|
|
16 to 22
|
5
|
high
|
> 90%
|
Performance:
• The area under the ROC curve for the derivation cohort was 0.90.
• The area under the ROC curve for the external validation cohort was 0.73.
