TDN Grading in Aneurysmal Subarachnoid Hemorrhage

Key Takeaways

• Investigators retrospectively applied TDN to charted adverse events in 355 treated patients, and higher grades were associated with longer hospitalization and poorer recovery.
• Higher TDN grades were linked to lower Glasgow Outcome Scale scores at discharge and at last follow-up in this cohort.
• TDN showed good discrimination for unfavorable follow-up outcome and employment status, with interpretation limited by the single-center retrospective design and selection bias.

The retrospectively applied Therapy–Disability–Neurology grading system appeared usable in a single-center aneurysmal subarachnoid hemorrhage cohort, with higher grades tracking greater downstream burden and an AUC of 0.82 for unfavorable outcome at last follow-up.

The analysis included surgically and/or endovascularly treated patients from 2009 to 2022 and examined adverse events documented during hospitalization after aneurysm treatment. In this cohort, higher TDN grades were also associated with longer admissions and worse later functional status.

The observational analysis used a prospectively collected database to examine a single-center aneurysmal subarachnoid hemorrhage cohort treated between 2009 and 2022. Researchers included 355 patients with proven aneurysmal subarachnoid hemorrhage who underwent surgical and/or endovascular treatment. Mean age was 57.2 years, 66.1% were female, and TDN grading was applied retrospectively to adverse events documented during the index hospitalization. Among the 355 patients, 318 had at least one adverse event, including intervention-related and disease-related complications, and outcomes included discharge and follow-up Glasgow Outcome Scale scores plus length of stay.

TDN grade showed a moderate positive correlation with length of stay, rho = 0.4, and adverse events added 7.63 hospital days on average, with p < 0.001 for both. Functional status moved in the opposite direction, with Glasgow Outcome Scale correlations of rho = -0.56 at discharge and rho = -0.58 at last follow-up. Discrimination was good for unfavorable outcome at follow-up, with AUC = 0.82, and more modest for employment status, with AUC = 0.71. In multivariable analysis, TDN remained independently associated with unfavorable outcome at last follow-up, with OR 5.76, 95% CI 3.69-9.01, and p < 0.001. Overall, higher TDN grades paralleled greater inpatient burden and worse functional status in this cohort.

Median follow-up was 22 months, follow-up data were available for 250 patients, and employment analyses included 190 patients below retirement age. The cohort excluded patients without endovascular or surgical treatment and those without enough documentation to determine TDN grade. These associations do not establish causality, and retrospective grading could have missed less severe events when routine documentation was incomplete. The primary length-of-stay analysis excluded in-hospital deaths, and sensitivity testing produced rho = 0.64 under an assumption the authors said could overstate correlation.