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Aneurysmal Subarachnoid Hemorrhage: Trends, Outcomes, and Predictions From a 15-Year Perspective of a Single Neurocritical Care Unit
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Aneurysmal Subarachnoid Hemorrhage: Trends, Outcomes, and Predictions From a 15-Year Perspective of a Single Neurocritical Care Unit
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Journal Article
Aneurysmal Subarachnoid Hemorrhage: Trends, Outcomes, and Predictions From a 15-Year Perspective of a Single Neurocritical Care Unit
2021
Overview
Abstract
BACKGROUND
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with disproportionally high mortality and long-term neurological sequelae. Management of patients with aSAH has changed markedly over the years, leading to improvements in outcome.
OBJECTIVE
To describe trends in aSAH care and outcome in a high-volume single center 15-yr cohort.
METHODS
All new admissions diagnosed with subarachnoid hemorrhage (SAH) to our tertiary neuro-intensive care unit between 2002 and 2016 were reviewed. Trend analysis was performed to assess temporal changes and a step-wise regression analysis was done to identify factors associated with outcomes.
RESULTS
Out of 3970 admissions of patients with SAH, 2475 patients proved to have a ruptured intracranial aneurysm. Over the years of the study, patient acuity increased by Hunt & Hess (H&H) grade and related complications. Endovascular therapies became more prevalent over the years, and were correlated with better outcome. Functional outcome overall improved, yet the main effect was noted in the low- and intermediate-grade patients. Several parameters were associated with poor functional outcome, including long-term mechanical ventilation (odds ratio 11.99, CI 95% [7.15-20.63]), acute kidney injury (3.55 [1.64-8.24]), pneumonia (2.89 [1.89-4.42]), hydrocephalus (1.80 [1.24-2.63]) diabetes mellitus (1.71 [1.04-2.84]), seizures (1.69 [1.07-2.70], H&H (1.67 [1.45-1.94]), and age (1.06 [1.05-1.07]), while endovascular approach to treat the aneurysm, compared with clip-ligation, had a positive effect (0.35 [0.25-0.48]).
CONCLUSION
This large, single referral center, retrospective analysis reveals important trends in the treatment of aSAH. It also demonstrates that despite improvement in functional outcome over the years, systemic complications remain a significant risk factor for poor prognosis. The historic H&H determination of outcome is less valid with today's improved care.
Graphical Abstract
Graphical Abstract
Publisher
Oxford University Press,Wolters Kluwer Health, Inc
Subject
/ Aged
/ Aneurysm, Ruptured - diagnostic imaging
/ Aneurysm, Ruptured - surgery
/ Diabetes
/ Endovascular Procedures - trends
/ Female
/ Humans
/ Intensive Care Units - trends
/ Intracranial Aneurysm - diagnostic imaging
/ Intracranial Aneurysm - surgery
/ Male
/ Research—Human—Clinical Studies
/ Stroke
/ Subarachnoid Hemorrhage - diagnostic imaging
/ Subarachnoid Hemorrhage - surgery
/ Trends
