COMMENTARY Commentary: Incorporating a Modified Graeb Score to the Modified Fisher Scale for Improved Risk Prediction of Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage eurosurgery grading scales serve 2 delayed cerebral ischemia (DCI), at least in the Peter Nakaji, MD important functions. One is as a clinical setting of the CONSCIOUS cohort from which N tool. As a rule, these sorts of scales the data are derived. IVH has been a variable Barrow Neurological Institute, Phoenix, should be easy to remember and calculate and risk factor in prior studies. In this study, IVH Arizona should be composed of elements with high inter- volume was as useful as cisternal clot thickness Correspondence: observer reliability. The Spetzler-Martin scale in predicting DCI. Peter Nakaji, MD, is the archetype for this in neurosurgery. The The authors acknowledge that the major value c/o Neuroscience Publications, second function is as a research tool, as a finite of adding the Graeb score is to reveal the strong Barrow Neurological Institute, set of elements that shed light on associations association of IVH with DCI. The scale itself St. Joseph’s Hospital and Medical Center, 350 W Thomas Rd, or causations that may not otherwise be readily may not have much near-term clinical use, but Phoenix, AZ 85013 apparent. Many are some combination of the one hopes that in the future, other researchers E-mail: Neuropub@Barrowneuro.org 2. The scale that the authors introduce in this investigating the same problem will be aware of paper is arguably more of the latter sort. It is too this study and factor the authors’ findings and Received, February 9, 2017. Accepted, April 14, 2017. cumbersome to be readily used as a clinical tool, methods into their own investigations. At some Published Online, June 1, 2017. and not so simple conceptually as the Fisher scale point, perhaps artificial intelligences will come or our recent Barrow Subarachnoid Hemorrhage into routine clinical use that will not be so picky Copyright 2017 by the Scale. about the complexity of these grading systems, as Congress of Neurological Surgeons From the standpoint of parsimony, it is long as they have utility. most elegant when a grading scale has a direct Disclosure relationship between grade and severity or risk that increases as the grade increases (see Figure The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described 1 in the paper, showing the Modified Fisher in this article. Scale Grade). For the new dichotomized scale grade (see Figure 2 in the paper ), the disparity between the 2a and 2b groups disrupts this REFERENCES continuity. It is true that it does not detract 1. Eagles ME, Jaja BNR, Macdonald RL. Incorpo- from its ability to tell us that intraventricular rating a modified Graeb Score to the modified Fisher Scale for improved risk prediction of delayed cerebral hemorrhage (IVH) is an important risk factor for ischemia following aneurysmal subarachnoid hemorrhage. Neurosurgery 2017, doi: 10.1093/neuros/nyx165. 2. Wilson DA, Nakaji P, Abla AA, et al. A simple and quantitative method to predict symptomatic vasospasm after ABBREVIATION: DCI, delayed cerebral ischemia; subarachnoid hemorrhage based on computed tomography: IVH, intraventricular hemorrhage beyond the Fisher scale. Neurosurgery 2012;71:869-75. 306 | VOLUME 82 | NUMBER 3 | MARCH 2018 www.neurosurgery-online.com Downloaded from https://academic.oup.com/neurosurgery/article-abstract/82/3/306/3859801 by Ed 'DeepDyve' Gillespie user on 16 March 2018
Neurosurgery – Oxford University Press
Published: Mar 1, 2018
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