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Prognostic features and outcome of surgically treated aneurysmal subarachnoid haemorrhage
Critical Care volume 5, Article number: P181 (2001)
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.
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.
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).
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.
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Tsaousi, G., Efthimiou, A., Selviaridis, P. et al. Prognostic features and outcome of surgically treated aneurysmal subarachnoid haemorrhage. Crit Care 5, P181 (2001). https://doi.org/10.1186/cc1248
- Glasgow Coma Scale
- Cerebral Aneurysm
- Glasgow Outcome Scale
- Aneurysmal Subarachnoid Haemorrhage