title: Impact of specialist neurovascular care in subarachnoid haemorrhage.
abstract: BACKGROUND
  The management of neurosurgical disorders has become increasingly specialised. The care of patients with subarachnoid haemorrhage (SAH) has generally been part of core neurosurgical practice, provided by general neurosurgeons whatever their specialist interest. The aim of this present study therefore is to ascertain if, and to what extent care provided by a dedicated neurovascular team (compared to care provided by a general neurosurgical team) change patient disposition in SAH.
  
  
  METHODS
  This is a retrospective analysis of SAH patients, identified from a departmental database of a single neurosurgical centre. In 2008, the service was reorganised such that a neurovascular team cared for all SAH patients. We compared clinical outcome in people admitted prior to this service reorganisation (Period A, 2004-2007) with patients admitted afterwards (Period B, 2009-2011). Survival and recovery were assessed according to the Glasgow Outcome Scale (GOS). Multi-factorial logistic regression analysis was performed to determine the injury and age adjusted incidence of complications, odds of survival at discharge, discharge home, mortality, good recovery (GOS 5) and favourable outcome, by dichotomising GOS (GOS 4-5 vs. GOS 1-3) at 3 months.
  
  
  RESULTS
  1114 patients were included in the study. The mean age of patients presenting in Period A (n = 543) was younger [50 years (SD 13.5)] than those in Period B (n = 571) [53 years (SD 13)]. Patients admitted in Period B were more likely to present as poor grade (World Federation of Neurological surgeons (WFNS) grades 4 and 5) compared to Period A (26.5% vs. 21.3%). No statistical differences between the groups in the incidence of pre-operative re-bleeding (3% vs. 5%) or rates of delayed cerebral ischaemia (16.1% vs. 16.1%) were observed. After adjustment for age, sex and injury severity, the odds of patient time to discharge, discharge home and good recovery (GOS 5) were 27% (p < 0.001), 45% (p = 0.001) and 93% (p < 0.001) higher respectively in Period B than Period A.
  
  
  CONCLUSIONS
  The data presented here demonstrates that management of SAH by a dedicated neurovascular team improves the potential for patient recovery.
authors.affiliation: Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK.
authors.forename: Assad U
authors.initials: AU
authors.lastname: Khan
authors.affiliation: Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Dulhanty
authors.affiliation: Centre for Biostatistics, Institute of Population Health, University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Vail
authors.affiliation: Institute of Cardiovascular Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK.
authors.forename: Pippa
authors.initials: P
authors.lastname: Tyrrell
authors.affiliation: Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK; Institute of Cardiovascular Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK.
authors.forename: James
authors.initials: J
authors.lastname: Galea
authors.affiliation: Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK; Institute of Cardiovascular Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Manchester, M6 8HD, UK. Electronic address: hiren.patel@srft.nhs.uk.
authors.forename: Hiren C
authors.initials: HC
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000592:standards*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013038:Specialization; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000592:standards*
keywords: Functional recovery; Neurointensive care; Organisation of stroke care; Outcome measures; Subarachnoid haemorrhage