Peer Review History
Original SubmissionNovember 23, 2022 |
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PONE-D-22-32313Validation of the accuracy of the modified World Federation of Neurosurgical Societies subarachnoid haemorrhage grading scale for predicting the outcomes of patients with aneurysmal subarachnoid haemorrhagePLOS ONE Dear Dr. Luong, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Mar 17 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
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Kind regards, Martin Kieninger Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 2. We noted in your submission details that a portion of your manuscript may have been presented or published elsewhere. Please clarify whether this conference proceeding or publication was peer-reviewed and formally published. If this work was previously peer-reviewed and published, in the cover letter please provide the reason that this work does not constitute dual publication and should be included in the current manuscript. 3. Please include a caption for figure 2. 4. Please upload a copy of Figure 2, to which you refer in your text on page 20. If the figure is no longer to be included as part of the submission please remove all reference to it within the text. 5. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments: I would like to apologize again for the long wait. However, the diametrically different assessments of Reviewer 1 and Reviewer 2 made a third review necessary. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know Reviewer #3: Yes ********** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ********** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is a very interesting study concerning the validation of modified World Federation of Neurosurgical Societies (WFNS) subarachnoid haemorrhage grading scale in predicting the 90-day poor outcome defined as modified Rankin Scale scores of 4 to 6. The validation process was also correlated to WFNS and H&H scores. The result showed more accurate than those in WFNS and H&H scores. The manuscript is well written and should be published. Reviewer #2: Thank you for submitting your manuscript. Your multi center analysis of the 3 SAH grades (WFNS, mWFNS and Hunt and Hess) was thoroughly performed. I however do have some comments. 1. It is stated that the WFNS is more complex to administer than the H&H scales because it requires the GCS and the motor function. First, I am not sure how it is more complicated than the H&H, since the GCS is a standard validated objective score that all neurosurgeon, and even emergency medicine doctors are all comfortable with. The H&H grade is very subjective. In addition, the WFNS score requires the GCS and the presence of a motor deficit only, which isn’t to complicated. 2. How many patients were excluded because of the initial GCs was not scored? Looking at the chart of the referring hospital or even the ambulance chart would yield the GCS. 3. Why were patients lost at 90 day? If surgical or even treated by embolization, were follow ups not performed? 4. The management of the aneurysmal SAH, let it be surgical or endovascular treatment, if very variable. The treatment option may play an important role in the outcome of the patient. Not having a standardized treatment option in these patients, and looking at the outcome is not adequate. This is a main caveat of the study. 5. It is stated that 415 patients presented to the study sites. How many were excluded because of the inadequate documentation of GCS? And how many and why where they lost to follow-up? 6. The conclusion that the mWFSN score was strongest associated with an increased risk of poor outcome at 30/90 days of ictus is a strong statement. This needs to be revised accordingly to the limits of the study. 7. Although their data do support their conclusion, I do not believe that this has any clinical impact, nor does it help in the clinical decision making of the surgeon /radiologist. Although interesting, the data inclusion criteria is very weak. Reviewer #3: The authors present the results of a prospective trial in patients with aneurysmal SAH, attempting to analyze the predictive value of SAH scales for poor outcome. This is an interesting study that carries high importance for the field. However, there are a number of aspects that need to be addressed before publication. • How long was the median follow-up time? • Were there any changes of patient status after 90 days ? • What was the outcome at discharge? • In the participants and treatment section, it is mentioned that “In the case of aphasia, patients were classified according to the clinically possible GCS scores derived from their eye and motor scores. How exactly is the “eye score” performed, and how was it implemented in the GS scale? • How were missing data handled? • Since the applied SAH grading systems are on an ordinal scale niveau, how meaningful is the approach of calculating ROC, which usually requires continuous data as the diagnostic input variable? For example, formulating a resulting cut-off value of 2.5 for poor outcomes in the modified WFNS scale is clinically challenging to implement. Please elaborate. • Comparing odd`s ratios between groups and models has been criticized, in fact, this approach has recently been rejected as an adequate method in this context. Several authors have argued that odds ratios will change if variables are added to the model, even if those additional variables are independent from the other variables. This concern particularly applies to the analysis of differences between clinical outcomes of the adjacent grades. Please comment on this critical aspect. • Clinically, there are a number of variables that may influence the results of this analysis. In particular, was there an influence of aneurysm location and the frequency of vasospasm / delayed ischemia? How many patients received decompressive craniectomy? • The strongest risk factor for poor outcome was the modified WFNS score of 3-5, which translates into an initial GCS score of 3-13. This variability makes the application of such a “risk - factor” somewhat challenging to implement in the clinical setting. • To my best knowledge, the modified WFNS score appears to carry a better discriminatory value for good outcomes compared to the original WFNS score. Do the authors find similar results for the patients with a good outcome? • Since the initial SAH grading is influenced by acute hydrocephalus, how many patients with acute hydrocephalus improved after implantation of an intraventricular drain? Did these patients show a different result regarding the SAH scales ad their prediction of poor outcomes? ********** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No ********** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. |
Revision 1 |
PONE-D-22-32313R1Validation of the accuracy of the modified World Federation of Neurosurgical Societies Subarachnoid Hemorrhage Grading Scale for predicting the outcomes of patients with aneurysmal subarachnoid hemorrhagePLOS ONE Dear Dr. Luong, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jul 24 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Martin Kieninger Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #3: All comments have been addressed Reviewer #4: All comments have been addressed ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #3: Yes Reviewer #4: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #3: Yes Reviewer #4: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #3: Yes Reviewer #4: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #3: Yes Reviewer #4: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #3: The authors have in fact carefully addressed all aspects I have raised in my review. I congratulate the authors for this important study Reviewer #4: Dear Dr. Luong. You and the manuscript writing team have made a great and highly precious work. I am really impressed by the study methodology as compared to the original WFNS, HH and MWFNS comparative reviews. The inclusion of all radiologic and epidemiological and clinical data, the transparent way of sample calculation and cut-off estimation as well as the logistic regression analysis were highly precise and well-performed. However, I would like the inclusion of 2 items to enhance the value of this great work: 1- inclusion of PAASH scale in the calculation for ROC analysis curve and the cut-off prognostication table. the 5-category Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH) grading scale has been shown by S.M. Dorhout Mees et al [DOI: 10.1161/STROKEAHA.107.498345] to show a more gradual increase of OR in ascending categories as compared to WFNS scale and as comparable to modified WFNS. In your work, your stated that " the modified WFNS scale did not show more gradual increases in OR for the 30- and 90-day poor outcome, in ascending grades, compared to the WFNS and H&H scales " , so inclusion of PAASH gradual OR prognostication to this context will render your manuscript more comprehensive and recognizable. Additionally, the mRS 4-5 were defined by you as a poor outcome, though some papers include mRS 3 as well. An explanation for the situation of mRS 3 patient categories will be highly valuable. These notes don't demerit your valuable work. Rather, they ensure more worldwide recognition of it. Thank you. ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #3: No Reviewer #4: Yes: Mohamed Mostafa ********** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. |
Revision 2 |
Validation of the accuracy of the modified World Federation of Neurosurgical Societies Subarachnoid Hemorrhage Grading Scale for predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage PONE-D-22-32313R2 Dear Dr. Dao, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Martin Kieninger Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #4: All comments have been addressed ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #4: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #4: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #4: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #4: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #4: I thank editors for their valuable consideration of my review points and would lije to express my apologies for late response due to urgent circumstances. Thank you for sharing me this spectacular chance. ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #4: Yes: Mohamed Mostafa ********** |
Formally Accepted |
PONE-D-22-32313R2 Validation of the accuracy of the modified World Federation of Neurosurgical Societies Subarachnoid Hemorrhage Grading Scale for predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage Dear Dr. Dao: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Martin Kieninger Academic Editor PLOS ONE |
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