Considerable delay in diagnosis and acute management of subarachnoid haemorrhage.
BACKGROUND
Rebleeding from subarachnoid haemorrhage (SAH) usually occurs within the first six hours after the initial bleeding. Rebleeding can be prevented effectively with tranexamic acid (TXA). Although a broad consensus has evolved that SAH should be treated as an emergency, it is likely that delays do exist in the diagnosis and treatment of SAH patients. The aim of this study was to prospectively assess the interval between symptom onset, emergency room (ER) admission, initial diagnosis and treatment, and final closure of the aneurysm.


METHODS
We prospectively studied the time course from the initial bleeding to ER admission, computed tomography (CT), TXA treatment, referral to the neurosurgical department, and to the final closure of the aneurysm.


RESULTS
A total of 133 patients with SAH due to ruptured intracranial aneurysms were admitted to two neurosurgical units in Copenhagen, Denmark, during a one-year period. The median time to admission was 60 min. The median delay from admission to CT scan was 55 min. Long pre-hospital delay (p = 0.03) and high Glasgow Coma Scale score on arrival (p = 0.0006) were associated with a longer time to CT scan. The median time from CT scan to initiation of TXA treatment was 50 min. The median time from initial insult to final closure of the aneurysm was 30 hours.


CONCLUSIONS
The present study demonstrates that considerable diagnostic delays exist in connection with CT and TXA treatment after patients' arrival to the ER.
Larsen
Carl Christian
CC
Department of Neurosurgery, Glostrup Hospital, 2600 Glostrup, Denmark. larsen-cc@hotmail.com
Eskesen
Vagn
V
Hauerberg
John
J
Olesen
Charlotte
C
Romner
Bertil
B
Astrup
Jens
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D057210:Delayed Diagnosis; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014148:Tranexamic Acid / Q000627:therapeutic use; D055815:Young Adult
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid