Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Clinical Trial
Aggressive management of aneurysmal subarachnoid haemorrhage based on a papaverine angioplasty protocol.
The aim of this study was to analyse the results of intensive therapy unit management of aneurysmal subarachnoid haemorrhage incorporating angioplasty in the protocol. Two hundred consecutive patients were treated using a detailed protocol that included nimodipine, early aneurysm repair, and surveillance angiography. Angiography was performed on days 5 to 7 (or when the clinical state suggested the presence of vasospasm). ⋯ These differences failed to reach a significant difference. The average Intensive Therapy Unit stay for aneurysmal subarachnoid haemorrhage patients was 13.1 days with a mean cost to the hospital of $AUD 24,379. This protocol appears to be both a clinically and cost effective method of managing aneurysmal subarachnoid haemorrhage.
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The aim of this study was to determine the functional outcome and mortality in relation to the Glasgow coma score (GCS) on presentation in patients aged over 65 years with acute head injury. 2331 patients with head injury were identified by searching the neurosurgery database (1984-1996); 191 met the inclusion criteria and systematic review of medical records was undertaken. Functional outcome on discharge from hospital and mortality were tested statistically against GCS on presentation. Mortality overall was 33. 5%. ⋯ Comparison with outcome for the 132 patients with GCS >/=11, of whom 91 had satisfactory outcomes, was highly statistically significant (P<0.001). Elderly patients with presenting GCS <11 due to acute head injury have poor functional outcomes and high mortality rates. Conservative treatment of these patients should be considered.