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World Neurosurg. 2013 Dec;80(6):853-8. doi: 10.1016/j.wneu.2012.08.021. Epub 2012 Sep 25.

Which clinical variable influences health-related quality of life the most after spontaneous subarachnoid hemorrhage? Hunt and Hess scale, Fisher score, World Federation of Neurosurgeons score, Brussels coma score, and Glasgow coma score compared.

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  • 1Universitätsklinikum Ulm, Neurochirurgische Klinik, Ulm, Germany. Electronic address: Thomas.Kapapa@uniklinik-ulm.de.



To determine the strength of the correlation between the Hunt and Hess scale, Fisher score, Brussels coma score, World Federation of Neurosurgeons score, and Glasgow coma score and health-related quality of life.


Evaluable questionnaires from 236 patients (5.6 years [± standard deviation, 2.854 years] on average after hemorrhage) were included in the analysis. Quality of life was documented using the MOS-36 item short form health survey. Because of the ordinal nature of the variables, Kendall tau was used for calculation. Significance was established as P ≤ 0.05.


Weak and very weak correlations were found in general (r ≤ 0.28). The strongest correlations were found between the Glasgow coma score and quality of life (r = 0.236, P = 0.0001). In particular, the "best verbal response" achieved the strongest correlations in the comparison, at r = 0.28/P = 0.0001. The Fisher score showed very weak correlations (r = -0.148/P = 0.012). The Brussels coma score (r = -0.216/P = 0.0001), Hunt and Hess scale (r = -0.197/P = 0.0001), and the World Federation of Neurosurgeons score (r = -0.185/P = 0.0001) revealed stronger correlations, especially in terms of the physical aspects of quality of life.


The Glasgow coma scale revealed the strongest, and the Fisher score showed the weakest correlations. Thus the Fisher score, as an indicator of the severity of a hemorrhage, has little significance in terms of health-related quality of life.

Copyright © 2013 Elsevier Inc. All rights reserved.


BP; Bodily pain; Brussels coma score; Clinical factors; GH; General health; Glasgow coma score; Health-related quality of life; Hunt and Hess scale; MH; MOS-36 Item Short Form Health Survey; Mental health; PCS; PF; PHSS; PYSS; Physical component summary; Physical functioning; Physical sum score; Psychological sum score; RE; RP; Role emotional; Role physical; SF; SF36; Social functioning; Subarachnoid hemorrhage; VT; Vitality; WFNS score

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