• Neeraj Sunderrajan Naval, Tiffany Chang, Filissa Caserta, Robert G Kowalski, Juan Ricardo Carhuapoma, and Rafael J Tamargo.
• Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. nnaval1@jhmi.edu
• J Crit Care. 2013 Apr 1;28(2):182-8.

ObjectiveManagement of aneurysmal subarachnoid hemorrhage (aSAH) has evolved over the past 2 decades, including refinement of neurosurgical techniques, availability of endovascular options, and evolution of neurocritical care; their impact on SAH outcomes is unclear.Design/MethodsProspectively collected data of patients with aSAH admitted to Johns Hopkins Medical Institutions between 1991 and 2009 were analyzed. We compared survival to discharge and functional outcomes at initial clinic appointment postdischarge (30-120 days) in patients admitted between 1991 and 2000 (phase 1 [P1]) and 2000 and 2009 (phase 2 [P2]), respectively, using dichotomized Glasgow Outcome Scale (good outcome: Glasgow Outcome Scale 4-5).ResultsA total of 1134 consecutive patients with aSAH were included in the analysis (P1 46.4%, P2 53.6%). There were higher rates of poor grade Hunt and Hess (P1 23%, P2 28%; P < .05), admission Glasgow Coma Scale score lower than 8 (P1 14%, P2 21%; P < .005), known medical comorbidites (P1 54%, P2 64%; P = .005), associated intraventricular hemorrhage (P1 47%, P2 55%; P < .05), and older population (P1 51.5%, P2 53.5%; P < .05) in P2. Good outcomes were more common in P2 (71.5%) compared with P1 (65.2%), with 2-fold adjusted odds of good outcomes after correction for various confounding factors (P < .001).ConclusionsOur institutional experience over 2 decades confirms that patients with aSAH have shown significant outcome improvements over time.Copyright © 2013 Elsevier Inc. All rights reserved.

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