title: Defining survivorship after high-grade aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Outcome after high-grade aneurysmal SAH is poor. Various treatment paradigms have been advanced to improve treatment outcome and preserve resources, but none have addressed the potential salvageable life lost.
  
  
  METHODS
  We retrospectively reviewed all patients with high-grade (H&H score, 4-5) aneurysmal SAH admitted to our institution from January 1998 to June 2002, all aggressively managed, to determine what clinical/radiographic criteria predicted favorable survival.
  
  
  RESULTS
  There were 50 patients analyzed. All underwent emergency ventriculostomies or clot evacuations. Twenty-three patients (46%) improved and 7 (14%) worsened; 41 survived to receive definitive therapy. Twenty-one patients (42%) overall achieved a favorable outcome (GOS, 4-5). In the multivariate analysis (stepwise logistic regression), the postresuscitation GCSm alone predicted outcome (P= .004) with 70% cases correctly identified, whereas age, location of aneurysm (anterior circulation or not), presence of intraventricular hemorrhage, time to definitive intervention, clot on computerized tomography, type of therapy used (coil vs clip), pupillary abnormalities, and preresuscitation GCSm did not. Because the sole predictive parameter is obtained postresuscitation, no clinical or radiographic factor on presentation appears valid to determine eligibility for definitive care.
  
  
  CONCLUSIONS
  Overall treatment outcome of our series is comparable with those of other articles. Our experience, as well as review of literature, does not support the existence of a validated "triage" schema to selectively treat patients with high-grade subarachnoid hemorrhage, implying that all such patients should be managed aggressively.
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA. mquigley@wpahs.org
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Quigley
authors.forename: Montell
authors.initials: M
authors.lastname: Salary
mesh_terms: D016887:Cardiopulmonary Resuscitation; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D015995:Prevalence; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000401:mortality* / Q000534:rehabilitation / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D014696:Ventriculostomy