(727) Aneurysmal Subarachnoid Hemorrhage Risk Model Accurately Identifies Patients for Early Discharge

Introduction: Patients with aneurysmal subarachnoid hemorrhage (aSAH) are often hospitalized for 21 days due to the risk of complications. However, some may never experience complications and are unlikely to benefit from 21-day hospitalization. The aim of this study is to derive a risk assessment model (RAM) using data from the first 14 days of hospitalization to identify low-risk patients for early discharge.

Methods: Patients >18 years old with acute aSAH from 2017-2024 at a comprehensive stroke center were included. Baseline demographics, admission aSAH grading scales, and complications requiring intervention were characterized. Complications included: vasospasm, DCI, CSW, cerebral edema, seizures, arrhythmias, respiratory failure, and hydrocephalus; medications to treat each complication were characterized for confirmation. Binary logistic regressions with leave-one-out cross validation (LOOCV) were used to identify a model for predicting patients at low risk for complications, by optimizing sensitivity and negative predictive value.

Results: Of 165 patients, the mean Hunt Hess score (HHS) was 2.5 (SD 1.2), modified Fisher Score (mFS) 3.1 (SD 1), endovascular therapy was used to secure aneurysm in 73%, and 90 experienced complications during days 15-21. In bivariate analyses, days 1-14 variables associated with days 15-21 complications were: HHS, mFS, middle cerebral artery (MCA) aneurysm, elevated TCD velocities, clinical/angiographic vasospasm, endovascular therapies for vasospasm, IVH, hydrocephalus, external ventricular drain (EVD) or lumbar drain (LD) placement, mechanical ventilation, use of vasopressors, hypertonic sodium solutions, benzodiazepines or propofol for seizures, milrinone, and fludrocortisone (all p< 0.05). LOOCV regression with a 6-variable model (mFS, HHS, fludrocortisone, EVD/LD, MCA aneurysm, and vasopressors) had an AUC=0.9 (0.85-0.95), sensitivity=0.94, specificity=0.69, PPV=79%, and NPV=91%.

Conclusions: This first ever RAM uses data during the first 14 days of hospitalization to identify patients at very low risk for complications after day 14. With 94% sensitivity, the RAM classifies patients who will not have complications and may assist in disposition on day 15 or beyond to consider early discharge. A multicenter validation cohort for this RAM is currently being studied.