How this model should be used
The presented model is used to predict the preinterventional risk of aneurysmal rebleeding within 24 and 72 hours after aneurysmal subarachnoid hemorrhage. The prediction score has been developed based on multinational cohort data from two prospective hospital registries and three retrospective observational studies in Europe (n = 2075, of whom 269 suffered preinterventional rebleeding; DOI: 10.1227/neu.0000000000002045). The score has been externally validated using data from two European hospital registries (n = 1467, of whom 143 suffered preinterventional rebleeding; DOI: 10.1227/neu.0000000000003275).
Context information
Because this validation study used observational data, it isdifficult to rule out selection- and information bias. Although the DCA suggests clinical usefulness, the real scientific test of how the ARISE models affect decision-making in daily clinical patient care is an impact study. This prediction tool should be used exclusively by health care professionals as a complementary tool to estimate the preinterventional rebleeding risk.
Model performance
The ARISE base showed promise at external validation. The ARISE base model has good discriminative ability for the prediction of a preinterventional rebleed in patients suffering from aSAH (c-statistic >0.70), although updating the baseline hazard for each center was needed to obtain adequate model calibration. After local validation and adjustment of the baseline hazard if required, the ARISE base model may well be used for risk prediction in patients with aSAH facilitating future endeavors to minimize the risk of preinterventional rebleeding. Such local validation studies are generally recommended before clinical implementation.
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