title: Importance of the initial grade of subarachnoid hemorrhage in the patients with the age of 80 years and older from a single center analysis.
abstract: In the developed countries, especially Japan, elderly population is rapidly increasing, but outcomes of elderly patients with the age of 80 years and older suffering from subarachnoid hemorrhage (SAH) remain still unclear. We retrospectively reviewed the medical records of nontraumatic SAH patients aged 80 years and older, who were hospitalized in a single center between 1998 and 2009. There were 28 patients (80-90 years old and 75% female), representing 5.9% of all non-traumatic SAHs (n = 474). Of those, 16 patients received an intervention (ten clipping and six endovascular coiling) and the remaining 12 patients were managed conservatively. The median survival time of intervention group was 110 days and that of conservative group 49 days (p = 0.12, log rank analysis). Cox's proportional hazards model yielded two variables, the Japan Coma Scale (JCS) grade on admission ( hazard ratio: 2.93 [p = 0.009]) and conservative treatment (hazard ratio: 2.14 [p = 0.054]). In the outcome of the modified Rankin Scale between these two groups, logistic regression analysis had significant variable; the JCS grade on admission (odds ratio: 280, [p = 0.020]). In the elderly patients with good initial clinical condition, an acute intervention may have good outcome.
authors.affiliation: Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan. sasano-tky@umin.ac.jp
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Asano
authors.forename: Takehiro
authors.initials: T
authors.lastname: Watanabe
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shinohara
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Takanashi
authors.forename: Akiko
authors.initials: A
authors.lastname: Ogawa
authors.forename: Norio
authors.initials: N
authors.lastname: Fujii
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Tanaka
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Naito
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Furuya
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ueno
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Nakagomi
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000401:mortality; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D019635:Neurosurgical Procedures / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome