title: Timing of operation for poor-grade aneurysmal subarachnoid hemorrhage: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Subarachnoid hemorrhage is a common and dangerous disease with an unfavorable prognosis. Patients with poor-grade subarachnoid hemorrhage (Hunt & Hess Grades 4-5) are unconscious on admission. Because of the high mortality and disability rate associated with poor-grade subarachnoid hemorrhage, it is often treated conservatively. Timing of surgery for poor-grade aneurysmal subarachnoid hemorrhage is still controversial, therefore this study aims to identify the optimal time to operate on patients admitted in poor clinical condition.
  
  
  METHODS
  Ninety-nine patients meeting the inclusion criteria were randomly assigned into three treatment groups. The early surgery group received operation within 3 days after onset of subarachnoid hemorrhage (day of SAH = day 1); the intermediate surgery group received operation from days 4 to 7, and surgery was performed on the late surgery group after day 7. Follow-up was performed 1, 3, and 6 months after aneurysm clipping. Primary indicators of outcome included the Extended Glasgow Outcome Scale and the Modified Rankin Scale, while secondary indicators of outcome were assessed using the Barthel Index and mortality.
  
  
  CONCLUSIONS
  This is the first prospective, single-center, observer-blinded, randomized controlled trial to elucidate optimal timing for surgery in poor-grade subarachnoid hemorrhage patients. The results of this study will be used to direct decisions of surgical intervention in poor-grade subarachnoid hemorrhage, thus improving clinical outcomes for patients.
  
  
  BACKGROUND
  Chinese Clinical Trial Registry: ChiCTR-TRC-12002917.
authors: Qiao
authors: Q
authors: Zhang
authors: Lu
authors: L
authors: Ma
authors: Yi
authors: Y
authors: Liu
authors: Min
authors: M
authors: He
authors: Hong
authors: H
authors: Sun
authors: Xiang
authors: X
authors: Wang
authors: Yuan
authors: Y
authors: Fang
authors: Xu-hui
authors: XH
authors: Hui
authors: Chao
authors: C
authors: You
mesh_terms: D023261:Glasgow Outcome Scale; D006801:Humans; D011379:Prognosis; D011446:Prospective Studies; D016037:Single-Blind Method; D013345:Subarachnoid Hemorrhage / Q000601:surgery*
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