title: Time intervals from aneurysmal subarachnoid hemorrhage to treatment and factors contributing to delay.
abstract: In the management of aneurysmal subarachnoid hemorrhage (aSAH), aneurysm treatment as early as feasible is mandatory to minimize the risk of a rebleed and may thus improve outcome. We assessed the different time intervals from the first symptoms of aSAH to start of aneurysm treatment in an effort to identify which factors contribute mostly to a delay in time to treatment. In 278 aSAH patients, time intervals between the different steps from initial hemorrhage to aneurysm treatment were retrospectively reviewed, and delaying factors were determined. Half of the patients presented to a hospital within 115 min (IQR 60-431). The median (IQR) interval from hemorrhage to diagnosis was 169 min (96-513), and from diagnosis to treatment 1,057 min (416-1,428), or 17.6 h. Aneurysm treatment started within 24 h in 76 % of treated patients. Independent factors predicting delay to treatment were primary presentation at a referring hospital and admission to the treatment center later in the day. Delay in treatment was not independently related to poor outcome. The interval to aneurysm treatment might be improved upon by immediate and direct transport to the treatment center combined with optimization of in-hospital logistics, following the 'time-is-brain' concept so successfully adopted in the treatment of ischemic stroke.
authors.affiliation: Academic Medical Center, Amsterdam, The Netherlands, mrgermans@hotmail.com
authors.forename: Menno
authors.initials: M
authors.lastname: Robbert
authors.forename: Menno R
authors.initials: MR
authors.lastname: Germans
authors.forename: Jantien
authors.initials: J
authors.lastname: Hoogmoed
authors.forename: H A Stéphanie
authors.initials: HA
authors.lastname: van Straaten
authors.forename: Bert A
authors.initials: BA
authors.lastname: Coert
authors.forename: W
authors.initials: W
authors.lastname: Peter Vandertop
authors.forename: Dagmar
authors.initials: D
authors.lastname: Verbaan
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000592:standards; D011379:Prognosis; D012017:Referral and Consultation / Q000592:standards; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013997:Time Factors