gms | German Medical Science

Objective: To assess the causes of 30-day in-hospital case fatality of patients with non-traumatic subarachnoid hemorrhage (nSAH).

Methods: Analysis (prospective study) of a consecutive series of 384 patients with nSAH over a period of the last 7 years and a fatal outcome within 30 days in hospital.

Results: There were 102 patients (29 men, 73 women with a mean age of 57,2 years, range 23-92 years) with a fatal outcome in hospital within 30 days after nSAH (26,6%). In 97 patients a cerebral aneurysm was confirmed as the bleeding source, in 5 patients (4,9%) this was impossible because of cerebral circulatory arrest. In 44 patients (43,1%) the ruptured aneurysm was secured by microsurgical clipping, in 21 patients (20,6%) with coiling and in one patient with microsurgical coating. With regard to rapid clinical deterioration no intervention with the intention to secure the ruptured aneurysm was performed in 36 patients (35,3%). Early brain damage with fatal brain swelling was the cause of case fatality in 46 patients (45,1%), and delayed cerebral ischemia (DCI) due to severe vasospasms in 46 patients (45,1%), sepsis with multiorgan failure in 6 patients (5,9%) and specific interventional complications (fatal bleeding) in 4 patients (3,9%). The majority of patients (84,9%) presented with a Hunt and Hess (HH) grade 5 (75,1%) or HH 4 (9,8%).

Conclusion: Early brain damage with fatal brain swelling and DCI are the main causes for 30-day in-hospital case fatality in a contemporary series of patients with nSAH. Female sex and a high HH grade present the most relevant risk factors.