gms | German Medical Science

Objective: Time is essential for immediate treatment of patients with ruptured aneurysms. Intracerebral bleedings, re-bleeding, brain herniation are life limiting factors. The current analysis was initiated to answer the question of time loss of critically ill patients with aneurysmal subarachnoid hemorrhage (SAH) until arrival at the neurosurgical unit and to identify factors for undue delays.

Method: All cases admitted to our center with the diagnosis of aneurysmal SAH from 2012-2015 were reviewed. ANOVA and unpaired t-test were used for statistical analysis.

Results: 297 patients were admitted to our department with aneurysmal SAH from 2012-2015. 51 of these patients were comatose with a GCS of 3 upon arrival of the emergency physician and were subject of further analysis. Time was mainly lost because of wrong initial diagnosis at the place of incident, leading to admission to a non-neurosurgical center (wrong vs right diagnosis; 214 vs 86 minutes, P<0.05 mortality 45 vs 21% P <0.05). Transport delay to a neurosurgical unit when first admitted of another hospital (262 vs 71 minutes, P< 0.001) was associated with a higher case fatality rate (46% vs 31% mortality, P<0.1). Analyzing the time lost in other hospitals showed that mortality was associated with prolonged stay at the first hospital (dead vs alive; 309 minutes vs 159 minutes, P<0.05). Time did not play a role for patient outcome when patients were admitted directly to our neurosurgical center (dead vs alive; 60 vs 75 minutes transport time). An immediate neurosurgical emergency procedure after admission to neurosurgery had a lower mortality (craniotomy: 35 vs 50% mortality, and external ventricular drain: 60 vs 92% mortality, not significant at P<0.05). The distance to the neurosurgical center did not play any role for transport time or outcome (dead vs alive: 18.7 km vs 25.5 km). Also transport during rush hour was not significant.

Conclusions: Transportation of critically ill SAH patients to the neurosurgical center is still not efficient enough. Patients are losing time through admissions to non-neurosurgical units, getting delayed cranial CTs and diagnoses and because of inefficient coordination of transportation. The lost time is a limiting factor for survival, hindering urgent neurosurgical procedures.