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Dr. Connolly Takes a FRESH Look at Patient Outcome After Subarachnoid Hemorrhage

Connolly8226One of the last things a loved one wants to hear is the phrase “a bleed into the brain.” It’s one of the most devastating diagnoses involving the brain that a patient can receive.

Known as subarachnoid hemorrhage, this rare diagnosis does indeed carry a grim prognosis. Up to 25 percent of nervous system–related deaths are caused by subarachnoid hemorrhage. And this does not include those subarachnoid hemorrhages caused by accidents or trauma.

Most commonly, a subarachnoid hemorrhage happens when an aneurysm bursts in the brain. An aneurysm arises from a weakened artery wall. Pressure from blood flow causes a part of the artery to blow up like a tiny balloon. And just as balloons do, aneurysms have the potential to burst.

When an aneurysm bursts, blood enters the space between the brain and its outer covering. This often causes a sudden severe headache—likely worse than the person has ever experienced. There may be vomiting, a stiff neck, confusion or seizures, or the patient may slip into a coma.

Although rare -about 1 in 10,000 people will experience a subarachnoid hemorrhage due to an aneurysm– more than 50 percent of people who experience this die. Those who survive are often left with brain damage, limiting their ability to function well on their own.

While no one can say for sure how a specific patient with subarachnoid hemorrhage will do, Columbia University Medical Center physicians are working hard to find ways of giving patients and loved ones a better idea of the prognosis. To this end, Columbia neurosurgeon, Dr. E. Sander Connolly; Columbia neurologist, Dr. Jan Claassen; and their colleagues* have developed what they call the FRESH score.

FRESH stands for Functional Recovery Expected after Subarachnoid Hemorrhage. The score is designed to give an indication of how well a patient is likely to function and what quality of life she can expect to have one year after having a bleed into the brain.

The doctors’ work is published in the Annals of Neurology.

They looked at data on over 1,600 Columbia University Medical Center/NewYork-Presbyterian Hospital patients with subarachnoid hemorrhage. Using modern statistical methods, they found several factors that were most helpful in predicting how a patient would do.

These included the severity of a headache and how alert the patient was upon admission to the hospital. They also included body temperature, the amount of white cells in the blood, age, and the presence of a second bleed within 48 hours.

The authors then fine-tuned the numbers and developed the scoring system known as the FRESH score. A lower score generally meant that a patient would do better.

Being able to predict how well a patient will fare after subarachnoid hemorrhage helps doctors provide the most appropriate treatment for their patients. Also, families are better able to plan for the amount and type of support their loved one might need. In developing the FRESH score, Dr. Connolly and his colleagues aim to provide care that goes beyond the operating room.

Learn more about Dr. Connolly on his bio page here.

Learn more about Columbia Neurosurgeons and the Department of Neurosurgery at Columbia here.

Learn more about Dr. Claassen on his bio page here.

*Full list of authors:

Jens Witsch, M.D., Hans-Peter Frey, Ph.D., Sweta Patel, P.A-C., M.H.S., Soojin Park, M.D., Shouri Lahiri, M.D., J. Michael Schmidt, Ph.D., Sachin Agarwal, M.D., Mari Cristina Falo, Ph.D., Angela Velazquez, M.D., Blessing Jaja, M.D., Ph.D., R. Loch Macdonald, M.D., Ph.D., E. Sander Connolly, M.D., Jan Claassen, M.D., Ph.D.

patient journey

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