• Young Hoon Choi, Eun Jin Ha, Youngbo Shim, Jungook Kim, Yoon-Hee Choo, Hye Seon Kim, Sung Ho Lee, Kang Min Kim, Won-Sang Cho, Hyun-Seung Kang, and Jeoug Eun Kim.
• Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
• Neurocrit Care. 2024 Feb 1; 40 (1): 177186177-186.

BackgroundPoor-grade aneurysmal subarachnoid hemorrhage (aSAH), defined as Hunt and Hess (HH) grades IV and V, is a challenging disease because of its high mortality and poor functional outcomes. The effectiveness of bundled treatments has been demonstrated in critical diseases. Therefore, poor-grade aSAH bundled treatments have been established. This study aims to evaluate whether bundled treatments can improve long-term outcomes and mortality in patients with poor-grade aSAH.MethodsThis is a comparative study using historical control from 2008 to 2022. Bundled treatments were introduced in 2017. We compared the rate of favorable outcomes (modified Rankin Scale score 0-2) at 6 months and mortality before and after the introduction of the bundled treatments. To eliminate confounding bias, the propensity score matching method was used.ResultsA total of 90 consecutive patients were evaluated. Forty-three patients received bundled treatments, and 47 patients received conventional care. The proportion of patients with HH grade V was higher in the bundle treatment group (41.9% vs. 27.7%). Conversely, the proportion of patients with fixed pupils on the initial examination was higher in the conventional group (30.2% vs. 38.3%). After 1:1 propensity score matching, 31 pairs were allocated to each group. The proportion of patients with 6-month favorable functional outcomes was significantly higher in the bundled treatments group (46.4% vs. 20.7%, p = 0.04). The 6-month mortality rate was 14.3% in the bundled treatments group and 27.3% in the conventional group (p = 0.01). Bundled treatments (odd ratio 14.6 [95% confidence interval 2.1-100.0], p < 0.01) and the presence of an initial pupil reflex (odd ratio 12.0 [95% confidence interval 1.4-104.6], p = 0.02) were significantly associated with a 6-month favorable functional outcome.ConclusionsThe bundled treatments improve 6-month functional outcome and mortality in patients with poor-grade aSAH.© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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