Duration between aneurysm rupture and treatment and its association with outcome in aneurysmal subarachnoid haemorrhage

TY - JOUR

T1 - Duration between aneurysm rupture and treatment and its association with outcome in aneurysmal subarachnoid haemorrhage

AU - Hostettler, Isabel C

AU - Lange, Nicole

AU - Schwendinger, Nina

AU - Frangoulis, Samira

AU - Hirle, Theresa

AU - Trost, Dominik

AU - Gempt, Jens

AU - Kreiser, Kornelia

AU - Wostrack, Maria

AU - Meyer, Bernhard

N1 - © 2023. The Author(s).

PY - 2023/1/27

Y1 - 2023/1/27

N2 - Timely treatment of aneurysmal subarachnoid haemorrhage (aSAH) is key to prevent further rupture and poor outcome. We evaluated complications and outcome adjusting for time from haemorrhage to treatment. Retrospective analysis of aSAH patients admitted between 2006 and 2020. Data was collected using standardized case report forms. We compared risk factors using multivariable logistic regression. We included 853 patients, 698 (81.8%) were treated within 24 h. Patients with higher Hunt and Hess grades were admitted and treated significantly faster than those with lower grades (overall p-value < 0.001). Fifteen patients (1.8%) rebled before intervention. In the multivariable logistic analysis adjusting for timing, Barrow Neurological Institute score and intracerebral haemorrhage were significantly associated with rebleeding (overall p-value 0.006; OR 3.12, 95%CI 1.09-8.92, p = 0.03, respectively) but timing was not. Treatment > 24 h was associated with higher mortality and cerebral infarction in only the subgroup of lower grades aSAH (OR 3.13, 1.02-9.58 95%CI, p-value = 0.05; OR 7.69, 2.44-25.00, p-value < 0.001, respectively). Therefore treatment > 24 h after rupture is associated with higher mortality and cerebral infarction rates in lower grades aSAH. Delay in treatment primarily affects lower grade aSAH patients. Patients with lower grade aSAH ought to be treated with the same urgency as higher-grade aSAH.

AB - Timely treatment of aneurysmal subarachnoid haemorrhage (aSAH) is key to prevent further rupture and poor outcome. We evaluated complications and outcome adjusting for time from haemorrhage to treatment. Retrospective analysis of aSAH patients admitted between 2006 and 2020. Data was collected using standardized case report forms. We compared risk factors using multivariable logistic regression. We included 853 patients, 698 (81.8%) were treated within 24 h. Patients with higher Hunt and Hess grades were admitted and treated significantly faster than those with lower grades (overall p-value < 0.001). Fifteen patients (1.8%) rebled before intervention. In the multivariable logistic analysis adjusting for timing, Barrow Neurological Institute score and intracerebral haemorrhage were significantly associated with rebleeding (overall p-value 0.006; OR 3.12, 95%CI 1.09-8.92, p = 0.03, respectively) but timing was not. Treatment > 24 h was associated with higher mortality and cerebral infarction in only the subgroup of lower grades aSAH (OR 3.13, 1.02-9.58 95%CI, p-value = 0.05; OR 7.69, 2.44-25.00, p-value < 0.001, respectively). Therefore treatment > 24 h after rupture is associated with higher mortality and cerebral infarction rates in lower grades aSAH. Delay in treatment primarily affects lower grade aSAH patients. Patients with lower grade aSAH ought to be treated with the same urgency as higher-grade aSAH.

KW - Humans

KW - Subarachnoid Hemorrhage/therapy

KW - Retrospective Studies

KW - Risk Factors

KW - Cerebral Infarction/complications

KW - Aneurysm, Ruptured/therapy

KW - Treatment Outcome

KW - Intracranial Aneurysm/complications

U2 - 10.1038/s41598-022-27177-9

DO - 10.1038/s41598-022-27177-9

M3 - SCORING: Journal article

C2 - 36707604

VL - 13

SP - 1527

JO - SCI REP-UK

JF - SCI REP-UK

SN - 2045-2322

IS - 1

ER -