The Prognostic Power of Imaging in Subarachnoid Hemorrhage: Linking Scores to Outcomes

In a 479-patient retrospective cohort study, admission CT scores — particularly intraventricular hemorrhage (IVH) burden measured by the Graeb score — strongly predicted 12‑month functional outcome after subarachnoid hemorrhage, indicating that radiographic hemorrhage burden on arrival provides independent prognostic information.

Rather than replacing clinical scales, the study directly compared five commonly used CT-based admission scores head-to-head and quantifies their relative performance for 12‑month outcomes.

The retrospective cohort comprised 479 atraumatic SAH patients with outcomes assessed at 12 months, including unfavorable functional outcome, mortality, and long‑term complications. Multivariable models tested independent prediction by five admission imaging scores. All scores independently predicted 12‑month outcome, but Graeb and IVH scores showed the highest discriminative performance and provided incremental value when added to clinical grading, confirming that IVH‑oriented measures materially improve prognostic precision at admission.

Clinically, higher intraventricular hemorrhage burden and elevated Graeb scores correlated with greater 12‑month mortality and higher rates of long‑term complications, with the strongest associations observed for IVH‑focused metrics. These directional relationships were consistent across discrimination and multivariable analyses and were most evident in subgroups with aneurysmal bleeding.