TY - JOUR
T1 - Early Treatment Decisions in Poor-Grade Patients with Subarachnoid Hemorrhage
AU - Hoogmoed, Jantien
AU - Coert, Bert A.
AU - van den Berg, René
AU - Roos, Yvo B.W.E.M.
AU - Horn, Janneke
AU - Vandertop, W. Peter
AU - Verbaan, Dagmar
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Background: Patients with World Federation of Neurosurgical Societies (WFNS) grade V subarachnoid hemorrhage (SAH) mostly have a poor outcome. Correct identification of patients who might benefit from treatment remains challenging. We investigated which disease-related characteristics, present at admission, could identify patients with chance of good outcome. Methods: In total, 146 consecutive patients with WFNS grade V SAH (2002–2013) were included. Demographic and disease-related characteristics were compared between patients with a good outcome (Glasgow Outcome Scale 4 and 5) and a poor outcome (Glasgow Outcome Scale 1-3). Subgroups were made of patients with aneurysm treatment according to outcome; 1) good outcome; 2) poor outcome, with optimal general treatment; and 3) poor outcome, general treatment discontinued. Results: In total, 34 of the 146 patients had a good outcome (36% of all treated patients); 16 (47%) of these presented with a Glasgow Coma Scale score of 3, versus 65 (58%) of patients with a poor outcome (P = 0.33). Eleven (33%) patients in the good outcome group presented with pupillary abnormalities; 4 (12%) even had bilaterally fixed and dilated pupils, versus 49 (46%) in patients with a poor outcome (P < 0.01). In 51 patients, the aneurysm was not treated; all died. Conclusions: More than one third of all treated patients with WFNS grade V SAH had a good outcome. All patients in whom the aneurysm was not treated died. Reliable identification of patients who will reach good outcome, on the basis of symptoms on admission, seems impossible, as these symptoms are not discriminating enough.
AB - Background: Patients with World Federation of Neurosurgical Societies (WFNS) grade V subarachnoid hemorrhage (SAH) mostly have a poor outcome. Correct identification of patients who might benefit from treatment remains challenging. We investigated which disease-related characteristics, present at admission, could identify patients with chance of good outcome. Methods: In total, 146 consecutive patients with WFNS grade V SAH (2002–2013) were included. Demographic and disease-related characteristics were compared between patients with a good outcome (Glasgow Outcome Scale 4 and 5) and a poor outcome (Glasgow Outcome Scale 1-3). Subgroups were made of patients with aneurysm treatment according to outcome; 1) good outcome; 2) poor outcome, with optimal general treatment; and 3) poor outcome, general treatment discontinued. Results: In total, 34 of the 146 patients had a good outcome (36% of all treated patients); 16 (47%) of these presented with a Glasgow Coma Scale score of 3, versus 65 (58%) of patients with a poor outcome (P = 0.33). Eleven (33%) patients in the good outcome group presented with pupillary abnormalities; 4 (12%) even had bilaterally fixed and dilated pupils, versus 49 (46%) in patients with a poor outcome (P < 0.01). In 51 patients, the aneurysm was not treated; all died. Conclusions: More than one third of all treated patients with WFNS grade V SAH had a good outcome. All patients in whom the aneurysm was not treated died. Reliable identification of patients who will reach good outcome, on the basis of symptoms on admission, seems impossible, as these symptoms are not discriminating enough.
KW - Aneurysm
KW - Coma
KW - Subarachnoid hemorrhage
KW - Treatment
KW - Withholding treatment
UR - http://www.scopus.com/inward/record.url?scp=85052303266&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85052303266&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30077026
U2 - https://doi.org/10.1016/j.wneu.2018.07.212
DO - https://doi.org/10.1016/j.wneu.2018.07.212
M3 - Article
C2 - 30077026
SN - 1878-8750
VL - 119
SP - e568-e573
JO - World Neurosurgery
JF - World Neurosurgery
ER -