title: Changes in intervention and outcome in elderly patients with subarachnoid hemorrhage.
abstract: OBJECTIVE
  The elderly constitute a significant and increasing proportion of the population. The aim of this investigation was to study time trends in clinical management and outcome in elderly patients with subarachnoid hemorrhage.
  
  
  METHODS
  Two hundred eighty-one patients >/=65 years of age with aneurysmal subarachnoid hemorrhage who were accepted for treatment at the Uppsala University Hospital neurosurgery clinic during 1981 to 1998 were included. Hunt and Hess grades on admission, specific management components, and clinical outcomes were recorded. Three periods were compared: A, 1981 to 1986 (before neurointensive care); B, 1987 to 1992; and C, 1993 to 1998.
  
  
  RESULTS
  The volume of elderly patients (>/=65 years of age) increased with time, especially patients >/=70 years of age. Furthermore the proportion of patients with more severe clinical conditions increased. A greater proportion of patients had a favorable outcome (A, 45%; B, 61%; C, 58%) despite older ages and more severe neurological and clinical conditions. In period C, Hunt and Hess I to II patients had a favorable outcome in 85% of cases compared with 64% in period A. This was achieved without any increase in the number of severely disabled patients.
  
  
  CONCLUSIONS
  Elderly patients with subarachnoid hemorrhage can be treated successfully, and results are still improving. The introduction of neurointensive care may have contributed to the improved outcome without increasing the proportion of severely disabled patients. A defeatist attitude toward elderly patients with this otherwise devastating disease is not justified.
authors.affiliation: Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Johansson
authors.forename: K G
authors.initials: KG
authors.lastname: Cesarini
authors.forename: C F
authors.initials: CF
authors.lastname: Contant
authors.forename: L
authors.initials: L
authors.lastname: Persson
authors.forename: P
authors.initials: P
authors.lastname: Enblad
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002533:Cerebral Angiography; D003422:Critical Care; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data* / Q000639:trends; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013548:Sweden / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data; D014696:Ventriculostomy / Q000706:statistics & numerical data