title: Who is Likely to Present in Poor Neurologic Condition After Aneurysmal Subarachnoid Hemorrhage? Risk Factors and Implications for Treatment.
abstract: OBJECTIVE
  Neurologic condition at presentation is the most important predictor of morbidity and mortality from aneurysmal subarachnoid hemorrhage (aSAH). To guide management, it is important to identify patients who are at risk of presenting in poor neurologic condition after aSAH.
  
  
  METHODS
  We retrospectively reviewed medical records and imaging studies for 387 consecutive cases of aSAH that were managed at a major academic neurovascular center in the United States from January 2008 to December 2013. Clinically accessible patient and aneurysm characteristics were evaluated by univariable analysis and multivariable logistic regression to identify predictors of poor neurologic status at presentation.
  
  
  RESULTS
  For all aneurysms, multivariable logistic regression identified age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.04; P = 0.0129), aneurysm size (≥7 and <10 mm: OR, 1.78; 95% CI, 1.02-3.11; P = 0.0429; ≥10 mm: OR, 3.22; 95% CI, 1.82-5.70; P < 0.0001), and vertebrobasilar junction location (OR, 10.1; 95% CI, 1.93-52.5; P = 0.0060) as independent predictors of poor neurologic condition at presentation. For internal carotid artery (ICA) aneurysms, female gender (OR, 9.21; 95% CI, 1.54-55.1; P = 0.0151), hypertension (OR, 8.67; 95% CI, 1.80-41.7; P = 0.007), and size ≥7 mm (OR, 3.67; 95% CI, 0.852-15.8; P = 0.0807) were predictive of poor neurologic condition at presentation, with a C statistic of 0.842. No association was found between poor neurologic grade at presentation and smoking status or warfarin therapy.
  
  
  CONCLUSIONS
  Independent predictors of poor neurologic grade were identified for all, ICA, anterior cerebral artery/anterior communicating artery, middle cerebral artery, and posterior circulation aneurysms. A risk prediction chart was constructed using clinically accessible patient and aneurysm characteristics for poor presenting neurologic condition after ICA aneurysm rupture. These factors should be considered when counseling patients with unruptured intracranial aneurysms.
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Chua
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ajith J
authors.initials: AJ
authors.lastname: Thomas
authors.affiliation: Neurosurgical Service, Beth Israel Deaconess Medical Center, Brain Aneurysm Institute, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: cogilvy@bidmc.harvard.edu.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D014481:United States
keywords: Intracranial aneurysm; Outcomes; Subarachnoid hemorrhage