GLASGOW COMA SCALE IN THE PREDICTION OF OUTCOME AFTER EARLY ANEURYSM SURGERY

OBJECTIVE: A prospective study was performed to analyze whether the Gl asgow Coma Scale (GCS) was useful in predicting the outcome after earl y surgical intervention for aneurysmal subarachnoid hemorrhage (SAH). METHODS: In a consecutive series of 765 patients who underwent surgery for aneurysms within 7 days after SAH, the level of consciousness was assessed by the GCS just before surgery and the outcome was graded by the Glasgow Outcome Scale 6 months after surgery. RESULTS: The patien t distribution in accordance with the GCS sum scores in descending ord er from 15 to 3 was as follows: 334, 140, 58, 27, 20, 26, 27, 19, 26, 17, 20, 27, and 24 patients, respectively. In general, the higher the preoperative GCS score was, the better the surgical outcome was. The o verall surgical result was significantly correlated with the preoperat ive GCS score (rs = 0.615, P < 0.001). With respect to the levels that distinguish the outcome along the GCS axis, a significant difference in the outcome was observed only between the GCS scores of 15 and 14 ( P < 0.001, Wilcoxon test). CONCLUSION: The GCS proved useful in the pr eoperative evaluation of patients with SAH, in terms of outcome predic tion. It is suggested that the SAH scale proposed by the World Federat ion of Neurosurgical Societies be reexamined, because differences in o utcomes were not clear between the GCS scores of 13 and 12 or between those of 7 and 6, in which Grades III and IV and Grades IV and V are d ifferentiated in the scale, respectively.