Volume 2, Issue 8 --- December 15, 2015
BI-Weekly Focus: Bleed Size
The following Southwestern Aneurysm Severity Index (SASI) chart tells us several things about a patient's presentation. The patient's Hunt & Hess score, Non-Neuro ASA score, CT/MRI results, lesion location, and any modifiers are clearly reflected in this chart.
The only portion of this chart that is not easily identified, for the ABSTRACTOR, is the CT/MRI row. How big is the SAH? Thick or Thin? What is the size of the hematoma, in cm? Is there any IVH or HCP?
We are doing a great job of describing the bleed, but that does not always answer the question of Thick or Thin or what size the hematoma is, for the Abstractor.
Let's look at an Example:
Example: Large left fronto-temporal parachymal hematoma & diffuse SAH overlying the Left cerebral convexity with a small amount of IVH.
In this case, the Abstractor would know to circle IVH, but would not know which SAH or Hematoma criteria to circle.
The Abstractor can read that the bleed is diffuse, but is it in vertical layers <1mm or >/=1mm or is that a localized clot?
The Abstractor would also not know which hematoma to circle? Is the hematoma <3m or >3cm. It says large, but what does that mean?
How does this affect you? Documentation is key!
For an SAH, the Abstractor needs to know if:
- the blood is not noted
- the blood is <1mm diffuse or vertical layers
- the blood is in a localized clot and/or vertical layers >or= 1mm
- the blood is in the intracerebral or intraventricular clot with diffuse or no SAH
For a Hematoma, the Abstractor also needs to know if:
- the hematoma / intracerebral blood < 3cm
- the hematoma / intracerebral blood > 3cm