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57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

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Outcome of unselected patients with subarachnoid hemorrhage before and after ISAT triggered management changes

Outcome einer konsekutiven unselektierten Patientenserie mit aneurysmatischer Subarachnoidalblutung vor und nach ISAT-bedingter Änderung des Managementprotokolls

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  • corresponding author A. Raabe - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • J. Beck - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • J. Berkefeld - Institut für Neuroradiologie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • R. du Mesnil - Institut für Neuroradiologie, Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • H. Vatter - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • M. Setzer - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • R. Gerlach - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • V. Seifert - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.10.10

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc068.shtml

Veröffentlicht: 8. Mai 2006

© 2006 Raabe et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.

Gliederung

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Objective: The aim of this study was to investigate the outcome of patients with subarachnoid hemorrhage (SAH) in an unselected series admitted during a 3-year period before and a 2-year period after a change in our management protocol following the ISAT study. Our hypothesis was that such an analysis of unselected and consecutively treated patients should objectify the expected impovement in patient care that is believed to result from the impact of a new therapy modality or a new treatment algorithm.

Methods: Data were analyzed using our prospective database (n=822). Patients with unruptured aneurysms, angiography negative SAH, patients with SAH but untreated aneurysm and patients with less than 6 months of follow-up were excluded. A total of 205 patients were left for analysis of the 3 years before and 181 patients for analysis of the 2 year period following an ISAT triggered change in our management protocol. Data analysis was performed separately for good grade (WFNS 1-III) and poor grade patients (WFNS IV-V) in the two time periods. Endpoints were the percentage of patients with favourable outcome (Rankin 0-2) and of patients returning to work and to previous social level and the number of treatment complications.

Results: After ISAT, the rate of clipping significantly decreased in good grade (from 72% to 39%, p<0.001) and poor grade patients (from 62% to 46%, p<0.05). The percentage of good grade patients with favourable outcome after 6 months improved from 77% to 85%, p=0.2). Poor grade patients did worse (35% good outcome vs. 30% after ISAT, p=0.1). While more good grade patients returned to work (42% vs. 54%, p=0.12) or their previous social level (55% vs. 71%, p<0.05), the rate of poor grade patients with such outocome decreased (16% vs. 13% returning to work; 25% vs. 15% return to same level of social activity, p=0.1). The overall rate of treatment complications did not change.

Conclusions: The changes in management towards an increased preference for endovascular treatment that was triggered by the ISAT study did not lead to a uniform trend in patient outcome. Possible causes for this finding are discussed.