title: Improved aneurysmal subarachnoid hemorrhage outcomes: a comparison of 2 decades at an academic center.
abstract: OBJECTIVE
  Management of aneurysmal subarachnoid hemorrhage (aSAH) has evolved over the past 2 decades, including refinement of neurosurgical techniques, availability of endovascular options, and evolution of neurocritical care; their impact on SAH outcomes is unclear.
  
  
  METHODS
  Prospectively collected data of patients with aSAH admitted to Johns Hopkins Medical Institutions between 1991 and 2009 were analyzed. We compared survival to discharge and functional outcomes at initial clinic appointment postdischarge (30-120 days) in patients admitted between 1991 and 2000 (phase 1 [P1]) and 2000 and 2009 (phase 2 [P2]), respectively, using dichotomized Glasgow Outcome Scale (good outcome: Glasgow Outcome Scale 4-5).
  
  
  RESULTS
  A total of 1134 consecutive patients with aSAH were included in the analysis (P1 46.4%, P2 53.6%). There were higher rates of poor grade Hunt and Hess (P1 23%, P2 28%; P < .05), admission Glasgow Coma Scale score lower than 8 (P1 14%, P2 21%; P < .005), known medical comorbidites (P1 54%, P2 64%; P = .005), associated intraventricular hemorrhage (P1 47%, P2 55%; P < .05), and older population (P1 51.5%, P2 53.5%; P < .05) in P2. Good outcomes were more common in P2 (71.5%) compared with P1 (65.2%), with 2-fold adjusted odds of good outcomes after correction for various confounding factors (P < .001).
  
  
  CONCLUSIONS
  Our institutional experience over 2 decades confirms that patients with aSAH have shown significant outcome improvements over time.
authors: Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. nnaval1@jhmi.edu
authors: Neeraj Sunderrajan
authors: NS
authors: Naval
authors: Tiffany
authors: T
authors: Chang
authors: Filissa
authors: F
authors: Caserta
authors: Robert G
authors: RG
authors: Kowalski
authors: Juan Ricardo
authors: JR
authors: Carhuapoma
authors: Rafael J
authors: RJ
authors: Tamargo
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D000367:Age Factors; D000368:Aged; D002985:Clinical Protocols; D015897:Comorbidity; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000628:therapy*