Volume 5 Supplement 1

21st International Symposium on Intensive Care and Emergency Medicine

Open Access

Prognostic features and outcome of surgically treated aneurysmal subarachnoid haemorrhage

  • G Tsaousi1,
  • A Efthimiou1,
  • P Selviaridis2,
  • D Vasilakos1 and
  • M Yannakou1
Critical Care20015(Suppl 1):P181

DOI: 10.1186/cc1248

Received: 15 January 2001

Published: 2 March 2001

Introduction

Aneurysmal subarachnoid haemorrage (SAH) is a challenging pathology which remains a cause of considerable morbidity and mortality. We attempted to classify patients with aneurysmal SAH according to prognostic estimates, identifying cases with a certain risk profile.

Method

Retrospective chart review of 80 SAH patients admitted in our ICU following surgical ligation of cerebral aneurysm. The following clinical details were recorded: age, sex, ASA physical status (ASA-PS), timing of angiography and surgical treatment, pre-operative Glasgow Coma Scale, Hunt-Hess grade, admission angiographic features, length of sedation and ICU stay. Functional outcome was assessed by Glasgow Outcome Scale (GOS) upon ICU discharge. For statistical purpose two subgroups according to outcome were identified: a) GOS 1–3 (unfavorable outcome) and B) GOS 4-5 (good recovery). Statistical analysis was performed using Students' t-test and χ2 analysis.

Results

History of longstanding hypertension was recorded in 45% (n = 36) of the cases, while cigarette smoking in 48.7% (n = 39). Male to female ratio was 1.3:1. Early operation (within the first 3 days after the bleed) was performed 8.7% (n = 7) of the cases with a mortality rate of 43% (n = 3). Calcium antagonists (nimodipine) were administered to 90% of the patients in the study group.

In addition early hints for poor neurological outcome were also acquired from ASA-PS, pre-operative Hunt-Hess, evidence of angiographic spasm and presence of severe brain swelling intra-operatively (χ2-test, P < 0.001). Overall mortality rate was 5% (n = 4).

Conclusion

Our results indicate that age, neurological status upon admission, pre-existing medical condition, evidence of vasospasm and cerebral oedema are the most important determinants of outcome for patients with aneurysmal SAH, regardless of treatment utilized.

Table

 

GOS 1–3

GOS 4–5

 
 

(n = 20)

(n = 60)

P

Age (years)*

55.8 ± 9.9

50.2 ± 10.8

< 0.05

Time to angiography (days)*

11.8 ± 9.4

12.3 ± 8.2

ns

Time to surgery (days)*

24.1 ± 17.6

25.8 ± 14.4

ns

GCS*

11.1 ± 3.8

14.2 ± 0.7

< 0.001

Sedation in ICU (days)*

4.5 ± 4

0.8 ± 0.4

< 0.001

ICU stay (days)*

15.2 ± 21.9

2.3 ± 5.6

< 0.001

* Mean ± SD.

Authors’ Affiliations

(1)
Department of Anaesthesiology & ICU, AHEPA University Hospital
(2)
Department of Neurosurgery,Delfon 146A Street, AHEPA University Hospital

Copyright

© The Author(s) 2001

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