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

Abstract

BACKGROUND: Seizure is a signifcant complication in patients under acute admissionfor aneurysmal SAH and could result in poor outcomes. Treatment strategies to optimizemanagement will beneft from methods to better identify at-risk patients.OBJECTIVE: To develop and validate a risk score for convulsive seizure during acuteadmission for SAH.METHODS: A risk score was developed in 1500 patients from a single tertiary hospital andexternally validated in 852 patients. Candidate predictors were identifed by systematicreview of the literature and were included in a backward stepwise logistic regression modelwith 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 forcalibration using a goodness-of-ft test.RESULTS: The SAFARI score, based on 4 items (age = 60 yr, seizure occurrence before hospitalization, ruptured aneurysm in the anterior circulation, and hydrocephalus requiringcerebrospinal fluid diversion), had AUC = 0.77, 95% confdence interval (CI): 0.73-0.82 in thedevelopment cohort. The validation cohort had AUC = 0.65, 95% CI 0.56-0.73. A calibratedincrease in the risk of seizure was noted with increasing SAFARI score points.CONCLUSION: The SAFARI score is a simple tool that adequately stratifed SAH patientsaccording to their risk for seizure using a few readily derived predictor items. It maycontribute to a more individualized management of seizure following SAH.