La evaluación clínica e imagenológica de los pacientes con hemorragia subaracnoidea espontánea constituye un paso fundamental para el manejo y valoración pronóstica de estos enfermos. Esta investigación tuvo como objetivo determinar el comportamiento del estado neurológico inicial y la magnitud (imagenológica) del sangramiento en pacientes con hemorragia subaracnoidea espontánea. Se realizó un estudio observacional, descriptivo-correlacional y retrospectivo, que incluyó 96 pacientes con hemorragia subaracnoidea espontánea entre 2016 y 2021. Se determinó las frecuencias de las categorías de las escalas de Hunt y Hess (clínica) y de Fisher (imagenológica); se analizó la relación entre estas escalas y otras variables mediante análisis bivariado (Odds Ratio y su intervalo de confianza). Entre los resultados se encuentra que el 54% de los pacientes se ubicó en la categoría “grado II” de la escala de Hunt y Hess; solo tres pacientes (3%) presentaron grado V. Hubo asociación significativa entre la condición de ancianidad y la agrupación de los grados III-V de dicha escala (OR 2,6[1,1;6]). El 77% de los casos estuvo ubicado en los grados III y IV de la escala de Fisher, con predominio de esta última (46%); más de la mitad de los pacientes de 60 años o más fueron clasificados como grado IV (55%), a diferencia de lo observado en los menores de esa edad (37%). Se concluye que la serie estuvo caracterizada por el predominio del estado clínico favorable al ingreso, a pesar de grados elevados de sangramiento según la escala imagenológica de Fisher. En los adultos mayores en particular, se observó mayor deterioro clínico al ingreso, y mayor magnitud del sangramiento.
The occurrence of complications affects the evolution and darkens the prognosis of patients with spontaneous subarachnoid hemorrhage. The objective was to determine the incidence of neurological and non-neurological complications in a series of patients with spontaneous subarachnoid hemorrhage. An observational, descriptive-correlational and retrospective study of 96 patients with spontaneous subarachnoid hemorrhage between 2016 and 2021 was carried out. The frequency of different neurological and non-neurological complications was determined, as well as the relationship between the presence of neurological complications and other variables through analysis. bivariate (Odds Ratio and its confidence interval). Among the results it is found that 53% of the patients presented some type of neurological complication, which prevailed in those 60 years of age or older (62% vs 45%), in aneurysmal etiology (54% vs 27%) and when the diagnosis was made. in the first 48 hours of the onset of symptoms (56% vs 43%). The frequency of complicated patients increased from grade I to grade V on the Hunt and Hess scale (OR 30.6[8.2;113]), the same as on the Fisher scale (OR 11.6[3 ,1;43,2]). The most frequent neurological complication was intracranial hypertension (39%), while the non-neurological one was pneumonia (24%). It is concluded that the series of patients was characterized by a high frequency of neurological complications, among which intracranial hypertension predominated. An evident relationship was demonstrated between the worst grades on the Hunt and Hess and Fisher imaging scales, obtained in the patient's assessment on admission, and the higher incidence of neurological complications.
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