The shunt-dependency in symptomatic aneurysmal subarachnoid hemorrhage (SDASH) score is a harmonised score for the prediction of hydrocephalus requiring shunting after subarachnoid hemorrhage. The tool is employed in the acute phase to predict which patients will require shunting, rather than to assess them in late phase for candidacy 1.
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Usage
SDASH was described in 2018 and has not yet entered into widespread routine clinical use (c. 2024). Validation and clinical utility have been assessed with mixed results 3,4.
Score
The SDASH score is measured on a scale from 0 to 4 and includes select parameters from existing scales:
-
Barrow Neurological Institute score
1 point: ≥3
0 points: <3
-
1 point: ≥4
0 points: <4
-
acute hydrocephalus
2 points: present
0 points: absent
Acute hydrocephalus is defined radiographically as the development of ventricle enlargement on the basis of the third ventricle width and periventricular low density on CT within 72 hours of the aneurysmal rupture, and clinically as mental deterioration, memory impairment, gait disturbance, and urinary incontinence 2.
Interpretation
The probability of developing shunt-dependent hydrocephalus estimated by Diesing et al. was as follows 1:
0 points: 2.9%
1 point: 18.6%
2 points: 40.6%
3 points: 50%
4 points: 76.2%
The influence of additional factors such as the presence of a ventricular drain, increased daily CSF output, and/or aneurysm treatment strategy are unknown.
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