gms | German Medical Science

Objective: Subarachnoid hemorrhage (SAH) is still associated with high morbidity and mortality. Therefore, specialized neurointensive care is desirable in the acute stage in order to prevent major clinical impairment in the critical first hours post-injury. Our objective was to evaluate the clinical course of SAH patients depending on their admission, comparing primary admission to our metropolitan university hospital with referrals from external hospitals.

Method: Patients who suffered from aneurysmal SAH in the period from Jan 2010-Oct 2012 were enrolled in this study and were divided into three groups depending on the source of primary admission (group 1 = university hospital; group 2 = external hospital with a neurological/neurosurgical (nl/ns) department; group 3 = external hospital without a nl/ns department). Statistical analysis was performed with one-way ANOVA and likelihood-ratio Chi-Square analysis to compare age, initial Glasgow Coma Scale (GCS), Hunt & Hess grade (H&H), Fisher grade, length of stay and Glasgow Outcome Scale (GOS) at discharge.

Results: A total 175 patients could be included in this study (group 1: n = 57, group 2: n = 100, group 3: n = 18). Hunt & Hess grade was 3.02 ± 1.43 in group 1, 2.70 ± 1.29 group 2 and 2.06 ± 1.21 group 3 (p=0.028). Percentage of grades IV and V was 38.5 % in group 1. Initial GCS was 9.91 ± 5.05; 11.14 ± 4.83; 13.72 ± 3.16 (p=0.013). Patients admitted to our university hospital were older on average: 55.53 ± 14.87 vs. 52.33 ± 13.98 vs. 52.72 ± 11.62 (p=0.384). Fisher grade was similar in all groups: 3.36 ± 0.92 vs. 3.31 ± 0.95 vs. 3.38 ± 0.81 (p=0.926). The longest duration of hospital stay was seen in group 3 with 29.56 ± 13.66 (vs. 25.33 ± 12.02 for group 1 and 24.95 ± 10.50 for group 2, p=0.285) According to the Hunt & Hess grade, GOS was 3.07 ± 1.27 (H&H = 3.02); 3.63 ± 1.22 (H&H = 2.70); 3.83 ± 1.04 (H&H = 2.06; p=0.01).

Conclusions: Our data demonstrates that older patients who suffer from higher Hunt & Hess grades and lower initial GCS scores were more likely to be directly admitted to our hospital, underlining that local emergency services appropriately select patients who need urgent care in a specialized unit. Even if outcome in SAH patients admitted via an external hospital did not differ significantly from that of patients primarily admitted to a university hospital, one may assume that they would have experienced an even better clinical course if they had been admitted to a specialized neurointensive care unit primarily.