TY - JOUR
T1 - Why Do Patients with Poor-Grade Subarachnoid Hemorrhage Die?
AU - Hoogmoed, Jantien
AU - de Oliveira Manoel, Airton L.
AU - Coert, Bert A.
AU - Marotta, Thomas R.
AU - Macdonald, R. Loch
AU - Vandertop, W. Peter
AU - Verbaan, Dagmar
AU - Germans, Menno R.
N1 - Copyright © 2019 Elsevier Inc. All rights reserved.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Background: Poor-grade subarachnoid hemorrhage (SAH) has been associated with a high case fatality, either in the acute phase or in the later stages. The exact causes of death in these patients are unknown. Methods: We performed a retrospective study of all consecutive patients with SAH with World Federation of Neurosurgical Societies grade IV or V on admission from 2009 to 2013 at 2 tertiary referral centers in Amsterdam, the Netherlands, and Toronto, Ontario, Canada, who had died during their hospital stay. Results: Of 357 patients, 152 (43%) had died. Of these 152 patients, 87 (24%) had not undergone aneurysm treatment. The median interval to death was 3 days (interquartile range, 1–12 days) after initial hemorrhage. The major cause of death in both centers was withdrawal of life support (107 patients [71%]; 74 of 94 [79%] in Amsterdam and 33 of 58 [58%] in Toronto; P < 0.01), followed by brain death in 23 (15%; 16 of 58 [28%] in Amsterdam vs. 7 of 94 [7%] in Toronto; P < 0.01). The remaining causes of death represented <15%. Conclusions: The decision to withdraw life support was the major reason for death of patients with poor-grade SAH for an overwhelming majority of the patients. The exact reasons for withdrawal of life support, other than cultural and referral differences, were undetermined. Insight into the reasons of death should be prospectively studied to improve the care and clinical outcomes of patients with poor-grade SAH.
AB - Background: Poor-grade subarachnoid hemorrhage (SAH) has been associated with a high case fatality, either in the acute phase or in the later stages. The exact causes of death in these patients are unknown. Methods: We performed a retrospective study of all consecutive patients with SAH with World Federation of Neurosurgical Societies grade IV or V on admission from 2009 to 2013 at 2 tertiary referral centers in Amsterdam, the Netherlands, and Toronto, Ontario, Canada, who had died during their hospital stay. Results: Of 357 patients, 152 (43%) had died. Of these 152 patients, 87 (24%) had not undergone aneurysm treatment. The median interval to death was 3 days (interquartile range, 1–12 days) after initial hemorrhage. The major cause of death in both centers was withdrawal of life support (107 patients [71%]; 74 of 94 [79%] in Amsterdam and 33 of 58 [58%] in Toronto; P < 0.01), followed by brain death in 23 (15%; 16 of 58 [28%] in Amsterdam vs. 7 of 94 [7%] in Toronto; P < 0.01). The remaining causes of death represented <15%. Conclusions: The decision to withdraw life support was the major reason for death of patients with poor-grade SAH for an overwhelming majority of the patients. The exact reasons for withdrawal of life support, other than cultural and referral differences, were undetermined. Insight into the reasons of death should be prospectively studied to improve the care and clinical outcomes of patients with poor-grade SAH.
KW - Brain death
KW - Cause of death
KW - Humans
KW - Intensive care
KW - Intracranial aneurysm
KW - Subarachnoid hemorrhage
KW - Withholding treatment
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85071403275&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31398522
UR - http://www.scopus.com/inward/record.url?scp=85071403275&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.wneu.2019.07.221
DO - https://doi.org/10.1016/j.wneu.2019.07.221
M3 - Article
C2 - 31398522
SN - 1878-8750
VL - 131
SP - e508-e513
JO - World Neurosurgery
JF - World Neurosurgery
ER -