Amount of blood on computed tomography as an independent predictor after aneurysm rupture.
OBJECTIVE
After admission to the hospital of patients with aneurysmal subarachnoid hemorrhage, we assessed the predictive value of the extent of the hemorrhage on computed tomography in addition to that of clinical grading scales for poor outcome, infarction, and rebleeding.


METHODS
We studied 471 consecutive patients with aneurysmal subarachnoid hemorrhage and used logistic regression with step-wise forward selection of variables.


RESULTS
On admission, poor outcome was predicted by a low Glasgow Coma Scale score (odds ratio, 0.8; 95% confidence interval, 0.7-0.9); treatment with fluid restriction (2.5; 1.6-4.0); age over 52 (2.6; 1.7-3.9); loss of consciousness at ictus (1.7; 1.1-2.6); or a large amount of subarachnoid blood (2.0; 1.3-3.1). Delayed infarction was predicted by a large amount of subarachnoid blood (1.8; 1.2-2.6) or treatment with tranexamic acid (1.6; 1.1-2.4). Rebleeding was predicted by treatment with tranexamic acid (0.4; 0.3-0.7; protective effect); age over 52 (1.9; 1.2-3.0); loss of consciousness at ictus (1.7; 1.1-2.7); or admission to a neurosurgery service (0.6; 0.3-0.9; protective effect). Comparison of the observed and predicted outcome events showed that inclusion of the amount of subarachnoid blood into a predictive model added little to the prediction of poor outcome in general, but much to the prediction of delayed cerebral ischemia.


CONCLUSIONS
The total amount of subarachnoid blood on the initial computed tomogram has independent predictive power for the occurrence of delayed cerebral ischemia.
University Department of Neurology, University Hospital Utrecht, The Netherlands.
P J
PJ
Brouwers
D W
DW
Dippel
M
M
Vermeulen
K W
KW
Lindsay
D
D
Hasan
J
J
van Gijn
D000367:Age Factors; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D001769:Blood / Q000000981:diagnostic imaging*; D002544:Cerebral Infarction / Q000150:complications; D004311:Double-Blind Method; D015600:Glasgow Coma Scale; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012306:Risk; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D014148:Tranexamic Acid / Q000627:therapeutic use; D016896:Treatment Outcome
D014148:Tranexamic Acid