Outcomes from subarachnoid haemorrhage

Introduction

A retrospective assessment of the outcome of patients with poor-grade (World Federation of Neurosurgeons Grades 4 and 5) subarachnoid haemorrhage (SAH) at a regional neurosurgical centre. Previous studies have shown aggressive treatment of patients with a poor clinical grade of SAH is warranted as grading can improve following resuscitation and drainage of cerebrospinal fluid [1, 2]. Many units still withdraw treatment if these patients do not improve neurologically in the first 48 to 72 hours [3].

Methods

A retrospective analysis of the notes of 116 patients who were recorded as having a diagnosis of SAH was performed between October 2002 and January 2006. Patients were excluded if they were World Federation of Neurosurgeons Grade 1, 2 or 3, had a traumatic SAH or been incorrectly classified as having SAH.

Results

Of 116 patients identified with a diagnosis of SAH, 12 patients were excluded as they had a traumatic SAH, one patient had a dissection, one patient a subdural haemorrhage and one patient a basal ganglia haematoma. Thirteen patients had a Glasgow coma score >12. Eighty-eight patients were correctly deemed as poor grade. All poor-grade patients were admitted to the intensive therapy unit. Of these 88 patients, 34 (38.6%) survived. Twenty-four (70%) of the survivors were discharged home, eight (24%) to a care home, and two (6%) remained in hospital. Seventeen (50%) had a Glasgow Outcome Score of 4 or 5.

Conclusion

Outcomes from poor-grade SAH at James Cook University Hospital compare favourably with published data. Review of the literature gives a wide variation in outcome between 3.2% and 42%. It is our hypothesis that a combination of more aggressive critical care management combined with early intervention should result in a reevaluation of treatment plans in those with a historically perceived poor outcome.