Subarachnoid Hemorrhage Clinical Trial
— hWFNSOfficial title:
Impact of Herniation on WFNS Grading and Outcome in Spontaneous Subarachnoid Hemorrhage - a SWISS SOS Observational Trial
NCT number | NCT02304328 |
Other study ID # | 118/15 |
Secondary ID | |
Status | Completed |
Phase | |
First received | |
Last updated | |
Start date | December 2015 |
Est. completion date | August 2020 |
Verified date | September 2020 |
Source | University Hospital Inselspital, Berne |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
All patients (≥18 years) with a spontaneous SAH proven by computed tomography (CT), magnetic
resonance imaging (MRI) or lumbar puncture will be considered for this trial. Upon
presentation to a neurosurgical centre the patients will be treated according to the local
protocol. Upon admission the patient is clinically evaluated for occurrence of clinical signs
of brain herniation syndromes (anisocoria, bilateral dilated pupils, posturing). Usually
first line treatment includes neurological resuscitation (placement external cerebrospinal
fluid drainage in case of hydrocephalus, treatment of seizure, and general intensive care
measures). Hereafter, the patient is clinically evaluated for a second time. The patients
will be graded according to the usual WFNS scale and the modified "herniation WFNS" scale.
The whole treatment of the patient will be according to local clinical protocols. Outcome
will be measured at six and twelve months by trained investigators who are unaware of
clinical data. The primary endpoint is the difference of specificities of the WFNS and hWFNS
with respect to poor outcome (mRS 4-6) at 6 months after initial haemorrhage. Given that
specificity and sensitivity are negatively correlated, difference in sensitivity will be the
second primary outcome.
The null hypothesis to be tested is that the ratio of the true negative rates (specificity)
of the hWFNS and WFNS scores is 1.35 i.e. the new score will detect 35% more patients as
truly negative (good outcome) as compared to the old score. In addition and because of the
negative correlation between specificity and sensitivity we will also test that the ratio of
the true positive rate (sensitivity) is not below 0.82 i.e. the new score will not more than
18% less patients as truly positive (poor outcome).
Status | Completed |
Enrollment | 250 |
Est. completion date | August 2020 |
Est. primary completion date | June 2020 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Written informed consent of the patient or consent of patient's next of kin - Spontaneous SAH - Age: =18 - Glasgow coma scale (GCS) = 12. In intubated patients the GCS assessment will be performed after cessation of sedation or if not possible the last GCS score before intubation will be used Exclusion Criteria - SAH due to any other cause or structural abnormality of the brain (trauma, dissection, arterio-venous malformation, dural arterio-venous fistula) - Foreseeable difficulties in follow-up due to geographic reasons (e.g., patients living abroad) |
Country | Name | City | State |
---|---|---|---|
Switzerland | Kantonsspital Aarau | Aarau | |
Switzerland | University Hospital Basel | Basel | |
Switzerland | Department of Neurosurgery, University Hospital Bern | Bern | |
Switzerland | Hôpitaux Universitaires de Genève | Genève | |
Switzerland | CHUV Lausanne | Lausanne | |
Switzerland | Ospedale Regionale di Lugano - Civico e Italiano | Lugano | |
Switzerland | Kantonsspital St. Gallen | St. Gallen | |
Switzerland | Universitätsspital Zürich | Zürich |
Lead Sponsor | Collaborator |
---|---|
University Hospital Inselspital, Berne |
Switzerland,
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Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Positive predictive value of the WFNS and hWFNS with respect to poor outcome (mRS 4-6) at 6 months after initial hemorrhage | Comparison of the two scales (calculation); the basis is the mRS at 6 months | At 6 months | |
Secondary | Composite of dependency and mortality as assessed by the mRS (4-6) | At 12 months | ||
Secondary | Alternate WFNS Scale (WFNS compared to WFNS IV = GCS 6-12 and WFNS V=GCS 3-5) | On admission, i.e. at first contact with a neurosurgical Unit, and after neurological resuscitation, i.e. within 6 hours after admission | ||
Secondary | Residential care | Institution where 24/7 care is available | At 6 and 12 months | |
Secondary | Timing of WFNS grading | Before and after neurological resuscitation, i.e. within 6 hours after admission | ||
Secondary | Recurrent SAH | At 6 months | ||
Secondary | Midline shift in mm measured at the Level of the foramen of Monroe | On admission, i.e. at first contact with a neurosurgical Unit |
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