EXPRESS: The modified Hijdra scale for prediction of delayed cerebral infarcts after subarachnoid hemorrhage

Delayed cerebral ischemia (DCI) occurs several days after subarachnoid hemorrhage (SAH) and could therefore be mitigated by treatment intervention. As testament to the great challenge of designing effective trials, however, the prevalence and severity of DCI have remained unchanged for decades. A critical need in the development of novel prophylactic treatments is optimizing initial prediction for DCI, since improved risk stratification based on prognosis could increase the statistical power of randomized trials, thereby increasing the probability of success and reducing costs. The primary objective of this study, using secondary analysis of data from the DISCHARGE-1 trial, was to evaluate the power of initial variables (medical history, clinical examination, and pre-interventional CT) for predicting the volume of delayed infarcts in SAH survivors. In multivariate analysis of 164 early survivors with pre-interventional CT within 72 hours of the initial hemorrhage, the modified Hijdra scale (mHS) (β= -0.016, p<0.001) was the only independent predictor of infarct volume due to DCI, outperforming common clinical scores und manually segmented hemorrhage volumes. Furthermore, early brain injury (EBI) volume identified high-risk patients for early death early on. Thus, we propose a combined approach using mHS and EBI volume for early risk stratification in randomized trials targeting DCI.

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Journal
Journal of Cerebral Blood Flow & Metabolism
Published
2026-06-17
DOI
https://doi.org/10.1177/0271678x261463954
Primary Topic
Intracranial Aneurysms: Treatment and Complications
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article
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article

EXPRESS: The modified Hijdra scale for prediction of delayed cerebral infarcts after subarachnoid hemorrhage

Alon Friedman, Jed A. Hartings, Viktor Horst, Jens P. Dreier et al.
Journal of Cerebral Blood Flow & Metabolism
Intracranial Aneurysms: Treatment and Complications
article

EXPRESS: The modified Hijdra scale for prediction of delayed cerebral infarcts after subarachnoid hemorrhage

Alon Friedman, Jed A. Hartings, Viktor Horst, Jens P. Dreier, Vasilis Kola, Peter Martus, Karl Schoknecht, Prabin Basnet, Svetlana Lublinsky, Sebastian Major, Nils Hecht, Johannes Woitzik, Maren Winkler, Michael Scheel, Coline Lemale, Stefan Wolf, Peter Vajkoczy
article en

Abstract

Delayed cerebral ischemia (DCI) occurs several days after subarachnoid hemorrhage (SAH) and could therefore be mitigated by treatment intervention. As testament to the great challenge of designing effective trials, however, the prevalence and severity of DCI have remained unchanged for decades. A critical need in the development of novel prophylactic treatments is optimizing initial prediction for DCI, since improved risk stratification based on prognosis could increase the statistical power of randomized trials, thereby increasing the probability of success and reducing costs. The primary objective of this study, using secondary analysis of data from the DISCHARGE-1 trial, was to evaluate the power of initial variables (medical history, clinical examination, and pre-interventional CT) for predicting the volume of delayed infarcts in SAH survivors. In multivariate analysis of 164 early survivors with pre-interventional CT within 72 hours of the initial hemorrhage, the modified Hijdra scale (mHS) (β= -0.016, p<0.001) was the only independent predictor of infarct volume due to DCI, outperforming common clinical scores und manually segmented hemorrhage volumes. Furthermore, early brain injury (EBI) volume identified high-risk patients for early death early on. Thus, we propose a combined approach using mHS and EBI volume for early risk stratification in randomized trials targeting DCI.

Journal of Cerebral Blood Flow & Metabolism
Ben-Gurion University of the Negev (IL), Carl von Ossietzky Universität Oldenburg (DE), Dalhousie University (CA), Humboldt-Universität zu Berlin (DE), Berlin Institute of Health at Charité - Universitätsmedizin Berlin (DE), Evangelisches Krankenhaus Oldenburg (DE), Bernstein Center for Computational Neuroscience Berlin (DE), Einstein Center for Neurosciences Berlin (DE), Freie Universität Berlin (DE), Charité - Universitätsmedizin Berlin (DE), University of Tübingen (DE), University of Cincinnati Medical Center (US), Leipzig University (DE)
Good health and well-being
Openalex Percentile: Top 6%
Intracranial Aneurysms: Treatment and Complications
DOISourceOpenAlex
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