Article
Does delayed hospital admission of patients with aneurysmal subarachnoid haemorrhage translate into worse clinical outcome? Results of a single-centre propensity score analysis
Ist eine verzögerte stationäre Aufnahme von Patienten mit aneurysmatischer Subarachnoidalblutung mit einem schlechteren Outcome assoziiert? Ergebnisse einer Propensity Score-Untersuchung
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Authors
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Lukas Goertz
- Universitätsklinikum Köln, Köln, Deutschland
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Muriel Pflaeging
- Universitätsklinikum Köln, Köln, Deutschland
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Roland H. Goldbrunner
- Universitätsklinikum Köln, Köln, Deutschland
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Gerrit Brinker
- Universitätsklinikum Köln, Köln, Deutschland
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Boris Krischek
- Universitätsklinikum Köln, Köln, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Early aneurysm embolization and standardized neurointensive care treatment within a neurovascular center are considered as key principles in the treatment of patients with aneurysmal subarachnoid haemorrhage (aSAH) in order to minimize secondary brain injury. In this study, patients with early (<24 hours; EHA) and delayed hospital admission (>48 hours; DHA) were compared in terms of baseline characteristics, treatment strategies, complications and clinical outcome.
Methods: Consecutive aSAH patients treated at a single neurovascular tertiary care center between 2009 and 2019 were reviewed. All patients were surveilled at a specialized neurointensive care unit, following a standardized aSAH management protocol. A 1:1 matching was performed based on individual propensity scores in order to account for diverging baseline characteristics.
Results: A total of 454 EHA patients and 55 DHA patients were included. DHA patients were significantly younger (52±11 vs. 56±14 years, P=0.03) and had lower World Federation of Neurosurgical Societies scores (P<.01) than EHA patients. DHA patients were finally admitted due to persisting symptoms in 46%, progressive symptoms in 27%, recurrent symptoms after initial improvement in 15% and new neurological deficits in 13%. Endovascular coiling was more often performed in DHA patients (62%) than in EHA patients (42%, P=0.03). Propensity score matching revealed a higher infarction rate in the DHA group (49%) than in the EHA group (26%, P=0.02). Vasospasm occurred slightly more often in DHA patients (57%) than in EHA patients (42%), without reaching statistical significance (P=0.12). There was no significant difference in mid-term functional outcome between the two groups (P=0.87) as determined by the modified Rankin scale.
Conclusion: Delayed hospital admission is associated with an increased cerebral infarction rate, which might be predominantly related to vasospasm. Nevertheless, a favourable outcome can be obtained by state-of-the-art neurointensive care treatment within a highly specialized center.
