Global Outcome Scales

The modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) (Table 6) are perhaps the two most common measures of global outcome used in aSAH research. The mRS (15) is increasingly being adopted as a primary endpoint in stroke clinical trials and has significant advantages over the GOS for evaluating aSAH patients because it has a smaller ceiling effect than the GOS. The scale describes death and 6 grades of disability and is able to describe the full spectrum of limitations after injury. The highest level includes patients who have no disability or symptoms related to their hemorrhage. Although inter-rater reliability meets criteria for satisfactory clinical assessment, there is room for improvement (15). The mRS has been used extensively in aSAH research. The GOS (16) was originally developed as an outcome scale for traumatic brain injury. Although it is still widely used, the categories tend to be broad, making it difficult to capture subtle improvements. In contrast to the mRS, the highest level of outcome on the GOS includes independent patients who continue to suffer from mild physical disability. However, it is well documented that patients in this best level of outcome may still suffer from devastating cognitive impairment (17).

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