Improved aneurysmal subarachnoid hemorrhage outcomes: A comparison of 2 decades at an academic center

Neeraj Sunderrajan Naval, Tiffany Chang, Filissa Caserta, Robert G. Kowalski, Juan Carhuapoma, Rafael J Tamargo

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)182-188
Number of pages7
JournalJournal of Critical Care
Volume28
Issue number2
DOIs
StatePublished - Apr 2013

Fingerprint

Subarachnoid Hemorrhage
Glasgow Outcome Scale
Endovascular Procedures
Glasgow Coma Scale
Appointments and Schedules
Hemorrhage
Survival
Population

Keywords

  • Aneurysm
  • Outcomes
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Improved aneurysmal subarachnoid hemorrhage outcomes : A comparison of 2 decades at an academic center. / Naval, Neeraj Sunderrajan; Chang, Tiffany; Caserta, Filissa; Kowalski, Robert G.; Carhuapoma, Juan; Tamargo, Rafael J.

In: Journal of Critical Care, Vol. 28, No. 2, 04.2013, p. 182-188.

Research output: Contribution to journalArticle

Naval, Neeraj Sunderrajan ; Chang, Tiffany ; Caserta, Filissa ; Kowalski, Robert G. ; Carhuapoma, Juan ; Tamargo, Rafael J. / Improved aneurysmal subarachnoid hemorrhage outcomes : A comparison of 2 decades at an academic center. In: Journal of Critical Care. 2013 ; Vol. 28, No. 2. pp. 182-188.
@article{4df729af547d4458a7af46b01b984cdb,
title = "Improved aneurysmal subarachnoid hemorrhage outcomes: A comparison of 2 decades at an academic center",
abstract = "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.",
keywords = "Aneurysm, Outcomes, Subarachnoid hemorrhage",
author = "Naval, {Neeraj Sunderrajan} and Tiffany Chang and Filissa Caserta and Kowalski, {Robert G.} and Juan Carhuapoma and Tamargo, {Rafael J}",
year = "2013",
month = "4",
doi = "10.1016/j.jcrc.2012.05.008",
language = "English (US)",
volume = "28",
pages = "182--188",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "Elsevier BV",
number = "2",

}

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

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

UR - http://www.scopus.com/inward/record.url?scp=84875385487&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875385487&partnerID=8YFLogxK

U2 - 10.1016/j.jcrc.2012.05.008

DO - 10.1016/j.jcrc.2012.05.008

M3 - Article

C2 - 22835419

AN - SCOPUS:84875385487

VL - 28

SP - 182

EP - 188

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

IS - 2

ER -