title: The 12-lead electrocardiogram in patients with subarachnoid hemorrhage: early risk prognostication.
abstract: OBJECTIVE
  The aim of this study was to investigate if the electrocardiographic (ECG) abnormalities assessed early in the emergency department (ED) are associated with the in-hospital mortality of the patients with spontaneous subarachnoid hemorrhage (SAH).
  
  
  METHODS
  We studied prospectively a cohort of 222 adult patients with spontaneous SAH in an ED. A 12-lead ECG was performed for these patients in the ED. The patients were stratified into nonsurvivors and survivors based on the in-hospital mortality. The clinical characteristics, heart rate, corrected QT interval (QTc) and 7 predefined morphologic abnormalities were compared between these 2 groups of patients.
  
  
  RESULTS
  Compared with the survivors (n=178), the nonsurvivors (n=44) had significantly slower heart rate (75±23 vs 83±16, P=.018) and more prolonged QTc (492±58 vs 458±40, P=.001). There were significantly higher frequency of occurrence of ECG morphologic abnormalities (66% vs 37%, P=.001) and nonspecific ST- or T-wave changes (NSSTTCs; 32% vs 12%, P=.015) in the nonsurvivors compared with those in the survivors. Multiple logistic regression model identified QTc (odds ratio, 1.0; 95% confidence interval, 1.0-1.0; P=.005) and NSSTTC (odds ratio, 3.3; 95% confidence interval, 1.0-10.7; P=.047) as the significant ECG variables associated with in-hospital mortality.
  
  
  CONCLUSIONS
  The occurrence of NSSTTC and prolonged QTc assessed early in the ED are independently associated with the in-hospital mortality in adult patients with spontaneous SAH.
authors.affiliation: Department of Emergency Medicine, Cathay General Hospital, and School of Medicine, Fu-Jen Catholic University, Taipei 242, Taiwan.
authors.forename: Chien-Cheng
authors.initials: CC
authors.lastname: Huang
authors.forename: Chi-Hung
authors.initials: CH
authors.lastname: Huang
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Kuo
authors.forename: Chia-Meng
authors.initials: CM
authors.lastname: Chan
authors.forename: Jiann-Hwa
authors.initials: JH
authors.lastname: Chen
authors.forename: Wei-Lung
authors.initials: WL
authors.lastname: Chen
mesh_terms: D016009:Chi-Square Distribution; D004562:Electrocardiography / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology