Artikel
Hunt and Hess grade V aneurysmal subarachnoid haemorrhage – the effect of aggressive care on clinical outcome
Hunt und Hess Grad V aneurysmatische Subarachnoidalblutung – Effekt der aggressiven Behandlung auf das klinische Ergebnis
Suche in Medline nach
Autoren
Veröffentlicht: | 26. Juni 2020 |
---|
Gliederung
Text
Objective: Patients presenting with Hunt and Hess grade V aneurysmal subarachnoid hemorrhage (aSAH) are in extremely critical condition at admission, resulting in the assumption of a generally poor prognosis.
To gain further insight into the effect of instantaneous and straightforward treatment this study assessed the clinical outcome of 238 patients with aSAH Hunt and Hess grade V using our prospectively conducted database.
Methods: A total of 238 patients admitted into the authors′ clinic between January 2002 and November 2018 and were analyzed in regards of treatment and clinical outcome.
This period of time was divided into three terms, specifically 2002-2007, 2008-2012 and 2013-2018.
Clinical outcome was assessed using the modified Rankin Scale (mRS) and dichotomized into favorable (mRS score 0-3) versus unfavorable outcome (mRS score 4-6) at time of discharge, at 6 months and at 1 year after ictus.
Results
- Data was available for a total of 238 patients at discharge, 225 patients at 6 months and 195 patients at 1 year after ictus.
- In the time period from 2002-2007, 5.6% achieved favorable outcome at time of discharge, 4.9% after 6 months and 5.8% after 1 year.
- Patients in 2008-2012 achieved favorable outcome in 1.4% at discharge, 5.6 % at 6 months and 6.3% after 1 year.
- In contrast, patients treated from 2013-2018 achieved favorable outcome in 12.6% at discharge, 17.2% at 6 months, and 17.7% after 1 year.
- Comparing the rates of favorable outcome in the cohort of patients treated between 2002-2012 and the cohort treated between 2013-2018, the rates of favorable outcome differed significantly early as well as late during the treatment course with p=0.009 at discharge, p=0.006 at 6 months and p=0.02 at 1 year respectively.
Conclusion: Poor grade SAH patients Hunt and Hess grade V may achieve favorable outcome in the modern era in a significant number when treated in terms of aggressive care.