Modified Fisher Scale Distribution and In-Hospital Outcomes in Moderate and Severe Traumatic Brain Injury With Traumatic Subarachnoid Hemorrhage: A Retrospective Single-Center Study

Traumatic subarachnoid hemorrhage (tSAH) is a frequent imaging finding after traumatic brain injury (TBI) and has been associated with adverse clinical outcomes. The modified Fisher (mFisher) scale was developed for nontraumatic subarachnoid hemorrhage, and its descriptive distribution in patients with tSAH may help characterize radiographic injury burden.

Objective

To describe the distribution of mFisher grades and in-hospital outcomes among patients with moderate and severe TBI and tSAH treated at a tertiary neurosurgical service.

Methods

We conducted a retrospective, descriptive, single-center review of medical records from the Neurosurgery Service of Hospital Central de Maracay between 2015 and 2017. Of 205 records reviewed, 100 patients with documented moderate or severe TBI and tSAH comprised the analytic cohort. Demographic, clinical, imaging, treatment, and discharge-status variables were summarized using descriptive statistics. No inferential hypothesis testing or multivariable prognostic modeling was performed.

Results

Seventy-one patients had moderate TBI and 29 had severe TBI. The cohort was 87% male, with a mean age of 37.66 years. Overall mFisher grades were I in 48%, II in 13%, III in 34%, and IV in 5%. In the moderate-TBI group, grade I was most frequent (52.1%), whereas grade III was most frequent in the severe-TBI group (41.3%). Overall, 58% of patients were discharged alive and 42% died during hospitalization. Mortality was 26.8% among patients with moderate TBI and 79.3% among those with severe TBI. The Marshall CT classification was not documented in 60% of records.

Conclusion

In this retrospective cohort, higher mFisher grades were proportionally more common among patients with severe TBI than among those with moderate TBI, and in-hospital mortality was substantially higher in the severe-TBI group. Because the analysis was descriptive and did not adjust for injury severity or other confounders, these findings should not be interpreted as demonstrating independent prognostic performance of the mFisher scale. Further studies using prespecified inferential and multivariable methods are needed to evaluate its prognostic utility in tSAH.