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232747_NCS Currents_December_2_eMag

TECH CORNER FRESH Score App – Functional Recovery after Subarachnoid Hemorrhage By Susanne Muehlschlegel, MD, MPH, FNCS At the recent NCS Annual Meeting in Once all data has been entered, one clicks “calculate score” and Scottsdale, Jens Witsch and colleagues the score value is displayed. One has the option to then click from Columbia University presented their “FRESH Score Interpretation,” which reveals a data table with all research on the derivation and validation possible score values, highlighting the row of the calculated score of a functional recovery parsimonious score and percentages of the projected 12-month mRS categories. Once predicting the 12-month modifi ed Rankin the FRESH Score has been calculated, one has the option of also Scale (mRS) after subarachnoid hemorrhage. calculating the FRESH Cog Score and FRESH Quol Score. Both Derived from 1,619 consecutive, prospectively require the entry of one additional variable (years of education collected aneurysmal subarachnoid and pre-morbid GOS, respectively), and both results are again hemorrhage patients enrolled in the Columbia SAH outcome shown in a data table. project (1996-2014), the group presented the FRESH Score (“Functional Recovery Expected after SAH”). Despite its “crammed” appearance on the screen, I fi nd this app helpful, The fi nal score included age (dichotomized at 70 years), as it is answers the question of presenting Hunt & Hess grade, APACHE II, and rebleed within “how will my loved one do?” using 48 hours (yes/no). The authors also developed prediction scores prognosticators that are available for cognitive performance (FRESH Cog Score using Telephone early on. It is also derived from Interview for Cognitive Status) and quality of life (FRESH Quol and externally validated in patients Score using the Sickness-Impact-Profi le) at 12 months. The FRESH admitted and treated within the Cog Score was adjusted for years of education and the FRESH last 15 years in the era of modern Quol Score was adjusted for pre-morbid disability using the pre- neurocritical care. morbid Glasgow Outcome Scale. Questions remaining Finally, validation of these scores was conducted on an external are: what role does cohort of 413 SAH patients from the CONSCIOUS-1 Study. Per delayed cerebral the abstract, the area-under-the-curve (AUC) values for the scores ischemia play in terms were: FRESH Score 0.90, FRESH Cog Score 0.80, and FRESH Quol of cognitive outcomes Score 0.78. External validation of the FRESH Score showed an and why was it not AUC of 0.73. The other two scores could not be validated due to part of the scores? It the lack of corresponding outcome data collected. Unfortunately, has been one of the at the time of the deadline for this article, the manuscript had strongest predictors not been published yet. We will be on the lookout to understand of poor outcome more detail about the science behind the score, including after SAH, so I fi nd it handling of missing data. surprising that it did not make it into the In parallel with the development of the FRESH Score, the authors score. While we await also built a smart phone app (by Sweta Patel), which is available publication of the for free download from the Apple App Store. It is compatible with manuscript, I commend all Apple products, and requires iOS 8.2 or later. It is currently not the authors for creating available for other smart phone platforms. this useful iPhone app, which will likely add to The home screen allows the entry of all data on one single screen. the rapid dissemination The APACHE II score is part of the FRESH Score, and requires the of the score at the entry of 11 different laboratory values. In order to avoid a second bedside. screen for data entry, the laboratory value fi elds are quite small, requiring the user to concentrate greatly on the entry of the correct value in the correct fi eld. I can imagine that users with large fi ngers may fi nd the entry fi elds to be diffi cult to tap. While the authors attempted to create a “parsimonious” score, the entry of the required APACHE II values is cumbersome and looking them up takes several minutes, making the app a bit labor intensive. 24


232747_NCS Currents_December_2_eMag
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