• World Neurosurg · Mar 2023

    Analysis of factors influencing delayed presentation in Japanese patients with subarachnoid hemorrhage.

    • Norihito Shimamura, Takeshi Katagai, Hiroki Ohkuma, Nozomi Fujiwara, Ichiro Nakahara, Jun Morioka, Takakazu Kawamata, Tatsuya Ishikawa, Hiroki Kurita, Kaima Suzuki, Masaki Chin, Minami Uezato, Takatoshi Sorimachi, Yoshiaki Shiokawa, Yuichi Murayama, Tetsuya Ueba, and Fusao Ikawa.
    • Department of Neurosurgery, Hirosaki General Medical Center, Aomori, Japan; Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Aomori, Japan. Electronic address: n.shimamura@hirosaki-hosp.jp.
    • World Neurosurg. 2023 Mar 1; 171: e590e595e590-e595.

    ObjectiveSome aneurysmal subarachnoid hemorrhage (SAH) patients are delayed in their presentation. This can cause a washout of the subarachnoid hematoma and a potential misdiagnosis. As a result, they may suffer rerupture of the aneurysm and preventable deterioration. We investigated the factors that influence delayed SAH presentation.MethodsAneurysmal SAH patients treated at 9 stroke centers from 2002 to 2020 were included. Age, gender, pre-SAH modified Rankin scale, World Federation of Neurological Surgeons grade, Fisher group, day of presentation, aneurysm treatment method, past history of cerebral stroke, comorbidity of hypertension and/or diabetes mellitus, and modified Rankin scaleat discharge were assessed retrospectively. We formed 2 groups based on the day of presentation after the onset of SAH: day 0-3 (early) and other (delayed). Logistic regression analyses detected the factors that influenced the day of presentation and outcome for SAH. A P- value <0.05 was considered significant.ResultsDelayed presentation comprised 282 cases (6.3%) of 4507 included cases. Logistic regression analyses showed that patients in an urban area, of male gender, low WFNS grade and low Fisher group correlated significantly with a delayed presentation. But delayed presentation did not influence outcome at discharge.ConclusionsArea of residency and gender correlated with delayed presentation after SAH in Japan. Urbanization, male gender, and mild SAH lead patients to delay presentation. The factors underlying these tendencies will be analyzed in a future prospective study.Copyright © 2022 Elsevier Inc. All rights reserved.

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