• World Neurosurg · Nov 2018

    Early Treatment Decisions in Poor-Grade Patients with Subarachnoid Hemorrhage.

    • Jantien Hoogmoed, Bert A Coert, René van den Berg, Roos Yvo B W E M YBWEM Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands., Janneke Horn, W Peter Vandertop, and Dagmar Verbaan.
    • Department of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.hoogmoed@amc.uva.nl.
    • World Neurosurg. 2018 Nov 1; 119: e568-e573.

    BackgroundPatients with World Federation of Neurosurgical Societies (WFNS) grade V subarachnoid hemorrhage (SAH) mostly have a poor outcome. Correct identification of patients who might benefit from treatment remains challenging. We investigated which disease-related characteristics, present at admission, could identify patients with chance of good outcome.MethodsIn total, 146 consecutive patients with WFNS grade V SAH (2002-2013) were included. Demographic and disease-related characteristics were compared between patients with a good outcome (Glasgow Outcome Scale 4 and 5) and a poor outcome (Glasgow Outcome Scale 1-3). Subgroups were made of patients with aneurysm treatment according to outcome; 1) good outcome; 2) poor outcome, with optimal general treatment; and 3) poor outcome, general treatment discontinued.ResultsIn total, 34 of the 146 patients had a good outcome (36% of all treated patients); 16 (47%) of these presented with a Glasgow Coma Scale score of 3, versus 65 (58%) of patients with a poor outcome (P = 0.33). Eleven (33%) patients in the good outcome group presented with pupillary abnormalities; 4 (12%) even had bilaterally fixed and dilated pupils, versus 49 (46%) in patients with a poor outcome (P < 0.01). In 51 patients, the aneurysm was not treated; all died.ConclusionsMore than one third of all treated patients with WFNS grade V SAH had a good outcome. All patients in whom the aneurysm was not treated died. Reliable identification of patients who will reach good outcome, on the basis of symptoms on admission, seems impossible, as these symptoms are not discriminating enough.Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

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