title: Increased mortality of patients with aneurysmatic subarachnoid hemorrhage caused by prolonged transport time to a high-volume neurosurgical unit.
abstract: BACKGROUND
  Time has shown to be a relevant factor in the prognosis for a multitude of clinical conditions. The current analysis aimed to establish whether delayed admission to specialized care is a risk factor for increased mortality in case of high-grade aneurysmal subarachnoid hemorrhage.
  
  
  METHODS
  Consecutive patients with aneurysmal subarachnoid hemorrhage were enrolled retrospectively if they had a World Federation of Neurological Surgeons Grading System grade of 5. Predictor variables for in-hospital mortality reflecting demographic, spatial, temporal treatment, and neurological factors were recorded from hospital medical records and emergency physicians' reports. We performed statistical analysis on the influence between the predictor variables and in-hospital mortality.
  
  
  RESULTS
  The study included 61 patients with an average age of 58 years. The overall in-hospital mortality rate was 28% (17/61 patients). A delayed transport to specialized neurosurgical care was associated with increased in-hospital mortality. Transportation time was mainly prolonged in cases where an alternative diagnosis was made by the emergency physician. Mortality was highest in patients with cardiovascular complications of subarachnoid hemorrhage.
  
  
  CONCLUSIONS
  Delayed admission to specialized care is associated with a higher mortality rate in patients with high-grade aneurysmal subarachnoid hemorrhage. Accompanying non-neurosurgical, mainly cardiac complications might be a significant factor leading to delayed admission. The emergency physician should be aware that cardiovascular abnormalities are a relevant complication and sometimes the first identified clinical feature of high-grade subarachnoid hemorrhage.
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Jasper H
authors.initials: JH
authors.lastname: van Lieshout
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Iris
authors.initials: I
authors.lastname: Bruland
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Igor
authors.initials: I
authors.lastname: Fischer
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Jan F
authors.initials: JF
authors.lastname: Cornelius
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Marcel A
authors.initials: MA
authors.lastname: Kamp
authors.affiliation: Institute of Neuroradiology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Turowski
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Angelo
authors.initials: A
authors.lastname: Tortora
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Hans-Jakob
authors.initials: HJ
authors.lastname: Steiger
authors.affiliation: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. Electronic address: Athanasios.Petridis@med.uni-duesseldorf.de.
authors.forename: Athanasios K
authors.initials: AK
authors.lastname: Petridis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D000072226:Computed Tomography Angiography; D004632:Emergency Medical Services; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units; D061847:Hospitals, High-Volume; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D055815:Young Adult