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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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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

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  • presenting/speaker Lorena Maria Schenk - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Alexis Hadjiathanasiou - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Simon Brandecker - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Patrick Schuss - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Hartmut Vatter - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Erdem Güresir - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP011

doi: 10.3205/20dgnc304, urn:nbn:de:0183-20dgnc3049

Published: June 26, 2020

© 2020 Schenk et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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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.