title: Subarachnoid haemorrhage WFNS grade V: is maximal treatment worthwhile?
abstract: BACKGROUND
  Aneurysmal subarachnoid haemorrhage (SAH) WFNS grade V is commonly known to be associated with high mortality and a very poor prognosis for survivors. Therefore, maximal invasive therapy is frequently delayed until any spontaneous improvement with or without an external ventricular drainage occurs. The aim of the study was to verify possible predictive factors and the probability of a favourable outcome in maximally treated patients.
  
  
  METHODS
  One hundred and thirty-eight consecutive patients with WFNS grade V SAH were admitted between 03/2006 and 12/2010. Thirty-five patients died before aggressive therapy could proceed. One hundred and three patients received maximal treatment and were retrospectively evaluated. The outcome was assessed at discharge and in the follow-up with the Glasgow Outcome Scale. Univariate and multivariate linear regression models were performed to find predictors for an unfavourable outcome.
  
  
  RESULTS
  Despite treatment, early mortality was 30 % (n = 31). At discharge, the rate of both vegetative and severely disabled patients was 27 % (n = 28). Favourable outcome at discharge was observed in 16 % (n = 16) of cases, whereas in the follow-up it rose to 26 % (n = 27). Multivariate full model regression identified intraventricular haematoma (IVH) and increasing age as independently predictive for poor outcome.
  
  
  CONCLUSIONS
  Despite treatment, initial mortality and severe disability remain high. Nevertheless, a favourable outcome was achieved in 26 % of aggressively treated patients, rendering the withdrawal of maximal therapy for WFNS grade V SAH patients unacceptable today. In cases of old patients with IVH, the indication for aggressive therapy should be put in place more carefully due to a very poor prognosis.
authors: Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany. maria.wostrack@lrz.tum.de
authors: Maria
authors: M
authors: Wostrack
authors: Nora
authors: N
authors: Sandow
authors: Peter
authors: P
authors: Vajkoczy
authors: Bawarjan
authors: B
authors: Schatlo
authors: Philippe
authors: P
authors: Bijlenga
authors: Karl
authors: K
authors: Schaller
authors: Victoria
authors: V
authors: Kehl
authors: Kathrin
authors: K
authors: Harmening
authors: Florian
authors: F
authors: Ringel
authors: Yu-Mi
authors: YM
authors: Ryang
authors: Benjamin
authors: B
authors: Friedrich
authors: Michael
authors: M
authors: Stoffel
authors: Bernhard
authors: B
authors: Meyer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult