gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Duration between aneurysm rupture and treatment – association with outcome in aneurysmal subarachnoid haemorrhage

Dauer zwischen Aneurysmaruptur und Versorgung – Assoziation mit Outcome nach aneurysmatischer Subarachnoidalblutung

Meeting Abstract

  • presenting/speaker Isabel Hostettler - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Nicole Lange - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Nina Schwendinger - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Samira Frangoulis - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Theresa Hirle - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Dominik Trost - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Kornelia Kreiser - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Maria Wostrack - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland
  • Bernhard Meyer - Klinikum rechts der Isar, Department of Neurosurgery, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV035

doi: 10.3205/21dgnc037, urn:nbn:de:0183-21dgnc0371

Published: June 4, 2021

© 2021 Hostettler 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

Text

Objective: Timely treatment of an aneurysmal subarachnoid haemorrhage (aSAH) is key in order to prevent further rupture and increased poor functional outcome. We aimed to evaluate complications and outcome in patients treated for aSAH depending on the time from haemorrhage to treatment and analysed the influence of treatment delay.

Methods: We retrospectively analysed a prospectively collected database of patients with aSAH admitted to our institution due to the acute haemorrhage between March 2006 and March 2020. Demographic, clinical, and imaging data were collected using standardized case report forms. We compared risk factors using multivariable logistic regression.

Results: We included 853 patients. Mean age was 57.3 years, 568 (66.6%) of the patients were female. Out of 853 included patients, 698 (81.8%) were treated within 24 hours from acute haemorrhage and 155 (18.2%) after. Patients who were admitted within 24 hours were additionally stratified into following subgroups if exact time from the haemorrhage was available: <4h, <6 h, and <12 h, respectively. Patients with higher Hunt and Hess (HH) grades were admitted and treated significantly faster than those with lower aSAH grades (overall p-value <0.001). Overall, 15 patients (1.8%) rebled before or during intervention. In the multivariable logistic analysis adjusting for age, time from haemorrhage to intervention, Barrow Neurological Institute (BNI) score and intracerebral haemorrhage (ICH), BNI score and ICH were significantly associated with rebleeding before aneurysm occlusion (overall p-value 0.008; OR 3.11, 95%CI 1.09-8.91, p=0.04, respectively). Treatment within 24 hours was associated with a lower mortality and cerebral infarction in lower grades aSAH in our cohort (OR 0.32, 0.1-0.98 95%CI, p-value=0.05; OR 0.13, 0.04-0.41, p-value<0.001, respectively). There were no major differences to these results if treatment proceeded within 12 hours or earlier.

Conclusion: Treatment within 24 hours after aneurysm rupture is associated with a lower mortality and cerebral infarction rate. In our study, the delay in treatment with consequently higher complication rates primarily affected patients with initially lower grade aSAH. Regardless of the initial mild symptoms and the presumably stable clinical state, treatment delay in patients with lower grade aSAH appears to be obsolete; they ought be treated with the same urgency as higher-grade aSAH.