TY - JOUR
T1 - Improved aneurysmal subarachnoid hemorrhage outcomes
T2 - A comparison of 2 decades at an academic center
AU - Naval, Neeraj Sunderrajan
AU - Chang, Tiffany
AU - Caserta, Filissa
AU - Kowalski, Robert G.
AU - Carhuapoma, Juan Ricardo
AU - Tamargo, Rafael J.
PY - 2013/4
Y1 - 2013/4
N2 - Objective: Management of aneurysmal subarachnoid hemorrhage (aSAH) has evolved over the past 2 decades, including refinement of neurosurgical techniques, availability of endovascular options, and evolution of neurocritical care; their impact on SAH outcomes is unclear. Design/Methods: Prospectively collected data of patients with aSAH admitted to Johns Hopkins Medical Institutions between 1991 and 2009 were analyzed. We compared survival to discharge and functional outcomes at initial clinic appointment postdischarge (30-120 days) in patients admitted between 1991 and 2000 (phase 1 [P1]) and 2000 and 2009 (phase 2 [P2]), respectively, using dichotomized Glasgow Outcome Scale (good outcome: Glasgow Outcome Scale 4-5). Results: A total of 1134 consecutive patients with aSAH were included in the analysis (P1 46.4%, P2 53.6%). There were higher rates of poor grade Hunt and Hess (P1 23%, P2 28%; P < .05), admission Glasgow Coma Scale score lower than 8 (P1 14%, P2 21%; P < .005), known medical comorbidites (P1 54%, P2 64%; P = .005), associated intraventricular hemorrhage (P1 47%, P2 55%; P < .05), and older population (P1 51.5%, P2 53.5%; P < .05) in P2. Good outcomes were more common in P2 (71.5%) compared with P1 (65.2%), with 2-fold adjusted odds of good outcomes after correction for various confounding factors (P < .001). Conclusions: Our institutional experience over 2 decades confirms that patients with aSAH have shown significant outcome improvements over time.
AB - Objective: Management of aneurysmal subarachnoid hemorrhage (aSAH) has evolved over the past 2 decades, including refinement of neurosurgical techniques, availability of endovascular options, and evolution of neurocritical care; their impact on SAH outcomes is unclear. Design/Methods: Prospectively collected data of patients with aSAH admitted to Johns Hopkins Medical Institutions between 1991 and 2009 were analyzed. We compared survival to discharge and functional outcomes at initial clinic appointment postdischarge (30-120 days) in patients admitted between 1991 and 2000 (phase 1 [P1]) and 2000 and 2009 (phase 2 [P2]), respectively, using dichotomized Glasgow Outcome Scale (good outcome: Glasgow Outcome Scale 4-5). Results: A total of 1134 consecutive patients with aSAH were included in the analysis (P1 46.4%, P2 53.6%). There were higher rates of poor grade Hunt and Hess (P1 23%, P2 28%; P < .05), admission Glasgow Coma Scale score lower than 8 (P1 14%, P2 21%; P < .005), known medical comorbidites (P1 54%, P2 64%; P = .005), associated intraventricular hemorrhage (P1 47%, P2 55%; P < .05), and older population (P1 51.5%, P2 53.5%; P < .05) in P2. Good outcomes were more common in P2 (71.5%) compared with P1 (65.2%), with 2-fold adjusted odds of good outcomes after correction for various confounding factors (P < .001). Conclusions: Our institutional experience over 2 decades confirms that patients with aSAH have shown significant outcome improvements over time.
KW - Aneurysm
KW - Outcomes
KW - Subarachnoid hemorrhage
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U2 - 10.1016/j.jcrc.2012.05.008
DO - 10.1016/j.jcrc.2012.05.008
M3 - Article
C2 - 22835419
AN - SCOPUS:84875385487
SN - 0883-9441
VL - 28
SP - 182
EP - 188
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 2
ER -