Changes in Intervention and Outcome in Elderly Patients With Subarachnoid Hemorrhage

Abstract

Background and Purpose — The elderly constitute a significant and increasing proportion of the population. The aim of this investigation was to study time trends in clinical management and outcome in elderly patients with subarachnoid hemorrhage. Methods — Two hundred eighty-one patients ≥65 years of age with aneurysmal subarachnoid hemorrhage who were accepted for treatment at the Uppsala University Hospital neurosurgery clinic during 1981 to 1998 were included. Hunt and Hess grades on admission, specific management components, and clinical outcomes were recorded. Three periods were compared: A, 1981 to 1986 (before neurointensive care); B, 1987 to 1992; and C, 1993 to 1998. Results — The volume of elderly patients (≥65 years of age) increased with time, especially patients ≥70 years of age. Furthermore the proportion of patients with more severe clinical conditions increased. A greater proportion of patients had a favorable outcome (A, 45%; B, 61%; C, 58%) despite older ages and more severe neurological and clinical conditions. In period C, Hunt and Hess I to II patients had a favorable outcome in 85% of cases compared with 64% in period A. This was achieved without any increase in the number of severely disabled patients. Conclusions — Elderly patients with subarachnoid hemorrhage can be treated successfully, and results are still improving. The introduction of neurointensive care may have contributed to the improved outcome without increasing the proportion of severely disabled patients. A defeatist attitude toward elderly patients with this otherwise devastating disease is not justified.

Regionalization of Treatment for Subarachnoid Hemorrhage

“…We were unable to evaluate the independent impact of neurointensivists on outcomes, but prior studies suggest that their presence at high-volume hospitals may account for some of the benefit. 31,32 Although we relied heavily on estimates from a large cohort study of SAH treatment in California, 7 it is likely that our conclusions would have been the same if we had used data from other published cohort studies. The differences in in-hospital mortality between high-and low-volume hospitals have been measured variably, but each study has found a significant reduction in mortality at high-volume hospitals compatible with absolute differences greater than the 2.2% threshold we found for borderline cost-effectiveness.…”

Feasibility of a Curvature-based Enhanced Display System for Detecting Cerebral Aneurysms in MR Angiography

“…1 The risk of intervention may also be lowered by new intervention techniques 13 and by better patient management. 14 We believe that low-cost screening for small cerebral aneurysms would have a signiˆcant clinical role in the near future.…”

Endovascular Treatment for Unruptured Intracranial Aneurysms in Elderly Patients: Single-Center Report

“…In many developed countries, SAH after of 70 years of age has been a frequent pathology. 1,2,15,16,21,23,30,32,33 Some authors believe that there is not a persistent increase of rupture risk. They argue that a maximum level is reached by the age of 70 years, and then a decrease is expected.…”

“…Procedural morbidity has also been decreasing. 14,15,[19][20][21][23][24][25] In addition, unlike open surgery, endovascular morbidity and mortality seem to be less dependent on a patient's age. 11,31,34 Our series demonstrated that endovascular coiling of elderly patients with unruptured intracranial aneurysms is safe and effective.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Endovascular treatment of unruptured intracranial aneurysms has made remarkable progress during the past 10 years and has become widely used. [14][15][16][17][18] Selective embolization with detachable coils has been accepted as an alternative to surgical clipping, with lower morbidity and mortality rates. Endovascular coiling has allowed us to treat more patients, including elderly individuals, in whom surgical clipping is considered risky.…”