The SAFARI Score to Assess the Risk of Convulsive Seizure During Admission for Aneurysmal Subarachnoid Hemorrhage

Neurosurgery. 2018 Jun 1;82(6):887-893. doi: 10.1093/neuros/nyx334.

Abstract

Background: Seizure is a significant complication in patients under acute admission for aneurysmal SAH and could result in poor outcomes. Treatment strategies to optimize management will benefit from methods to better identify at-risk patients.

Objective: To develop and validate a risk score for convulsive seizure during acute admission for SAH.

Methods: A risk score was developed in 1500 patients from a single tertiary hospital and externally validated in 852 patients. Candidate predictors were identified by systematic review of the literature and were included in a backward stepwise logistic regression model with in-hospital seizure as a dependent variable. The risk score was assessed for discrimination using the area under the receiver operator characteristics curve (AUC) and for calibration using a goodness-of-fit test.

Results: The SAFARI score, based on 4 items (age ≥ 60 yr, seizure occurrence before hospitalization, ruptured aneurysm in the anterior circulation, and hydrocephalus requiring cerebrospinal fluid diversion), had AUC = 0.77, 95% confidence interval (CI): 0.73-0.82 in the development cohort. The validation cohort had AUC = 0.65, 95% CI 0.56-0.73. A calibrated increase in the risk of seizure was noted with increasing SAFARI score points.

Conclusion: The SAFARI score is a simple tool that adequately stratified SAH patients according to their risk for seizure using a few readily derived predictor items. It may contribute to a more individualized management of seizure following SAH.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Ruptured / classification*
  • Aneurysm, Ruptured / complications*
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Seizures / etiology*
  • Sensitivity and Specificity
  • Subarachnoid Hemorrhage / classification*
  • Subarachnoid Hemorrhage / complications*