A strategy to expeditious invasive treatment improves clinical outcome in comatose patients with aneurysmal subarachnoid haemorrhage.
In patients with poor clinical condition after aneurysmal subarachnoid haemorrhage (aSAH), treatment is often deferred until patients show signs of improvement. Early external ventricular drainage and aneurysm occlusion may improve prognosis also in poor grade patients. The clinical outcome of an expeditious approach was compared with that of a conservative approach.



In all, 285 consecutive World Federation of Neurological Surgeons (WFNS) grade V aSAH patients admitted to three university hospitals between January 2000 and June 2007 were included. Two hospitals followed an expeditious approach, one a more conservative approach. Groups were compared with respect to demographic and clinical characteristics and outcome. Univariable and multivariable analyses were performed to determine the associations with good outcome (Glasgow Outcome Scale scores 4-5), using logistic regression models.



Good outcome was seen more often in expeditiously treated patients [22% vs. 11%; odds ratio (OR) 2.24, 95% confidence interval (CI) 1.17-4.27]. Expeditiously treated patients more often underwent aneurysm occlusion than conservatively treated patients (64% vs. 27%; OR 4.86, 95% CI 2.93-8.05) and placement of an external ventricular catheter (82% vs. 31%; OR 10.05, CI 5.72-10.66). There was no significant difference in rebleeding between patient groups. Occlusion of the aneurysm was the only variable that remained significant in the multivariable model with an OR of 43.73 (95% CI 10.34-184.97).



An expeditious invasive treatment strategy in WFNS grade V aSAH patients can lead to a better outcome. Hesitance in the early stages seems a self-fulfilling prophecy for a poor outcome.
Department of Neurosurgery, Neurosurgical Centre Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands.
J
J
Hoogmoed
Department of Neuroradiology, Academic Medical Centre, Amsterdam, The Netherlands.
R
R
van den Berg
Department of Neurosurgery, Neurosurgical Centre Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands.
B A
BA
Coert
Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands.
G J E
GJ
Rinkel
Department of Neurosurgery, Neurosurgical Centre Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands.
W P
WP
Vandertop
Department of Neurosurgery, Neurosurgical Centre Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands.
D
D
Verbaan
D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured; D057785:Catheters; D002552:Cerebral Ventricles / Q000601:surgery; D003128:Coma / Q000209:etiology* / Q000628:therapy; D000072700:Conservative Treatment; D003422:Critical Care; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome
aneurysm; cerebrospinal fluid drainage; coma; outcome; subarachnoid haemorrhage; treatment