Outcome After Subarachnoid Haemorrhage

Of patients surviving the initial bleed and admitted within 3 days to the neurosurgical unit, approximately one-quarter die within the following 3 months. Over half make a good recovery and regain former employment, although in a proportion, minor personality change and intellectual deficit persist.

Factors providing a prognostic guide are: age, quantity of subarachnoid blood on CT scan, loss of consciousness at the ictus, clinical condition on admission and the presence of pre-existing hypertension or arterial disease.

Operative mortality (i.e. mortality rate in patients undergoing operation) ranges from 8-45% depending on the patient's clinical condition and the timing of operation. Management mortality takes into account all patients, including those not undergoing operation due to premature death or poor clinical condition. These figures are of more value when comparing results of different management regimes.

Operative mortality (at 6 months) No. of patients undergoing operation - 2922

Management mortality (at 6 months) No. of patients admitted to the centre within 3 days of the haemorrhage - 3521

Operative mortality (at 6 months) No. of patients undergoing operation - 2922

Preoperative

No.

Mortality(%)

Good

state

recovery(%)

alert

1882

8

78

drowsy

727

19

58

stuperose

202

35

33

comatose

111

45

13

Total

2922

14

68

Management mortality (at 6 months) No. of patients admitted to the centre within 3 days of the haemorrhage - 3521

State on

No.

Mortality(%)

Good

admission

recovery(%)

alert

1722

13

74

drowsy

1136

28 ,

54

stuperose

348

44

30

comatose

315

72

11

Total

3512

26

_

Adapted from Kassell, Torner, Haley et al. 1990. Journal of Neurosurgery 73; 18-36.

This is the largest recent study reviewing the timing of aneurysm surgery, collecting data from 68 neurosurgical centres throughout the world

Comparing different operative or management policies: Comparison of different treatments for ruptured aneurysms is difficult, unless conducted under the confines of a randomised controlled trial. 'Operative mortality' provides limited information unless patient groups are carefully matched for age, clinical condition and timing of operation. 'Management mortality' (e.g. outcome of all admitted patients up to 3 months from the ictus) is of more practical value, but even then, admission policies require careful scrutiny.

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