589 - Predictors of Recovery in Treated Aneurysmal Subarachnoid Hemorrhage: A Quantitative Assessment of Early Presentation Grading Scales

Monday, April 13, 2026

12:10 PM - 1:10 PM ET

Author/Co-author(s)

AR

Anastasios Roumeliotis, MD

Resident Physician
Northwestern Memorial Hospital, United States

Poster Presenter(s)

AK

Ashima Kundu, BS

Medical Student
Loyola Stritch School of Medicine, United States

Author/Co-author(s)

SG

Sachin Govind, MD

Physician
Northwestern Memorial Hospital, United States
MB

Matthew Botts, MD

Neurosurgery
Northwestern memorial Hospital, United States
BJ

Babak Jahromi, MD, PhD

Professor
Northwestern Memorial Hospital, United States

Purpose: Aneurysmal subarachnoid hemorrhage (aSAH) remains highly morbid despite advances in clipping and coiling. Most prognostic studies pool treated and untreated patients, confounding interpretation of admission variables. We aimed to identify predictors of functional outcome and complications in a uniformly treated cohort.

Materials and Methods: We retrospectively analyzed 129 consecutive aSAH patients who underwent surgical or endovascular treatment at a single academic center (2020–2023). Data included demographics, comorbidities, aneurysm features, Hunt–Hess (HH), WFNS, and Modified Fisher (mFisher) grades. Outcomes were modified Rankin Scale (mRS) at discharge, 3 months, and 12 months, and discharge disposition. Logistic regression identified predictors of favorable outcome (mRS 0–2), vasospasm, and discharge home.

Results: Mean age was 53.3±13.0 years; 72.9% were female. Hypertension (36.4%) and obesity (35.7%) were most common. Most aneurysms were anterior circulation (62.8%), mean dome size 5.5±3.3 mm. Mean HH was 2.4±1.2, WFNS 3.1±0.9, and mFisher 2.8±0.9. Radiographic vasospasm occurred in 50.4% and symptomatic vasospasm in 24.0%. Vasospasm correlated with higher HH (2.7 vs 2.4, p=0.0430), mFisher (3.1 vs 2.6, p=0.0125) and with longer hospital stay (20.6 vs 17.0 days, p=0.0169). At discharge, 51.2% achieved mRS 0–2 and 63.6% were discharged home; favorable mRS rose to 73.6% at 3 months and 77.5% at 12 months. Favorable outcomes were associated with younger age (49.3 vs 57.5 years, p=0.0003), shorter hospitalization (12.7 vs 21.5 days, p< 0.0001), absence of preoperative altered mental status (10.6% vs 57.1%, p< 0.0001), and lower HH and mFisher grades (p< 0.01). However, on multivariable regression only WFNS independently predicted favorable mRS at discharge (OR 0.34 per grade, p< 0.0001), 3 months, and 12 months. Aneurysm size, number, and mFisher did not retain significance.

Conclusion: In this large treated-only aSAH cohort, WFNS grade at presentation was the sole independent predictor of functional recovery through 12 months. While vasospasm was frequent and associated with higher mFisher grade, it did not independently affect disability. With a high morbidity and mortality, aSAH remains a difficult disease to manage, but understanding clinical grading scales such as WFNS can serve to better guide conversations with patients and family about long-term prognosis and functional outcome.