The key to improving prognosis for aneurysmal subarachnoid hemorrhage remains in the pre-hospitalization period.
BACKGROUND
Despite advances in neurosurgical management, aneurismal subarachnoid hemorrhage (aSAH) still has high mortality and morbidity. This study aimed to clarify how delaying hospital admission after aSAH contributes to worse prognosis even today and to find the possibility for an improvement of its prognosis by early admission.


METHODS
Four hundred twenty-one consecutive patients are the basis for this study. Cause of delay was classified into 5 categories: patient delay (PD), doctor delay (DD), transportation delay (TD), no delay (ND) (within 2 hours of onset), and others. Condition of each patient was assessed at time of onset and admission using H&K. The relationships between cause of delay and worsening of Hunt and Kosnik grading (H&K) were examined.


RESULTS
The median delay time was 1.7 days. Only 41% of patients visited our institution without delay. Admission delay, especially PD and DD, exhibited a significant correlation to worsening of H&K. In addition to nondirect admission, misdiagnosis or delayed diagnosis contributed significantly to worsening of H&K. Incidence of DD has declined in recent years, whereas that of PD has increased. Consequently, no change in total number of delays was found.


CONCLUSIONS
There remains much room for an improvement of prognosis for aSAH by early admission. We need to fully realize this reality and to directly face this problem.
Department of Neurosurgery, Masuda Red Cross Hospital, Masuda 698-8501, Japan. takeshi@med.shimane-u.ac.jp
Takeshi
T
Miyazaki
Fumihito
F
Ohta
Kouzo
K
Moritake
Akihiro
A
Nagase
Takato
T
Kagawa
D000289:Admitting Department, Hospital / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000592:standards / Q000706:statistics & numerical data; D002648:Child; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data / Q000639:trends; D003955:Diagnostic Tests, Routine / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D011379:Prognosis; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data