Incidence and Outcome of Aneurysmal Subarachnoid Hemorrhage

Abstract

Background and Purpose: The purpose of this study was to assess nationwide incidence and outcomes of aneurysmal subarachnoid hemorrhage (aSAH). The Swiss SOS (Swiss Study on Subarachnoid Hemorrhage) was established in 2008 and offers the unique opportunity to provide this data from the point of care on a nationwide level. Methods: All patients with confirmed aneurysmal subarachnoid hemorrhage admitted between January 1, 2009 and December 31, 2014, within Switzerland were recorded in a prospective registry. Incidence rates were calculated based on time-matched population data. Admission parameters and outcomes at discharge and at 1 year were recorded. Results: We recorded data of 1787 consecutive patients. The incidence of aneurysmal subarachnoid hemorrhage in Switzerland was 3.7 per 100 000 persons/y. The number of female patients was 1170 (65.5%). With a follow-up rate of 91.3% at 1 year, 1042 patients (58.8%) led an independent life according to the modified Rankin Scale (0–2). About 1 in 10 patients survived in a dependent state (modified Rankin Scale, 3–5; n=185; 10.4%). Case fatality was 20.1% (n=356) at discharge and 22.1% (n=391) after 1 year. Conclusions: The current incidence of aneurysmal subarachnoid hemorrhage in Switzerland is lower than expected and an indication of a global trend toward decreasing admissions for ruptured intracranial aneurysms. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03245866.

Impact of Age On Short-Term Outcomes After Discharge in Patients With Aneurysmal Subarachnoid Hemorrhage

“…As shown in Table 4, changes in the prevalence of good outcome after discharge were 8.4-55.2% according to the literature review. [2,5,18,24,25,30] In contrast, that of our study was lower at 6.9%. The reasons for this are thought to be due to the shorter evaluation period after discharge and the higher proportion of good outcomes at discharge in our study compared to those in the previous reports.…”

“…The changes in the prevalence of good outcome (mRS score: 0-2 or Glasgow Outcome Score: 4-5) between discharge and the last follow-up ranged from 8.4-55.2%. [2,5,18,24,25,30] The prevalence of improvement of mRS scores in total cases between discharge and at 6 months ranged from 57.4-61.0%, [5,30] and the prevalence of declined mRS scores during the same period was 17.0%. [30]…”

“…[19] Although there are many reports examining the outcomes several months after onset of aSAH, [3, 4, 6, 8, 10-12, 15, 20, 21, 29] few reports have discussed the changes in the prevalence of outcome at discharge and after discharge in recent aging situation. [2,5,18,24,25,30] There are only two reports, to date, of changes in the outcome of individual patients after discharge. [5,30] According to these reports, approximately 60% of patients with aSAH had improved modi ed Rankin Scale (mRS) scores at 6 months after onset, and only one report mentioned scale grade or mWFNS scale grade at admission (n = 26), mRS score at discharge and 3 months after onset (n = 31), type of treatment (n = 18), location of the aneurysm (n = 21), pre-onset mRS score (n = 15), Fisher CT grade (n = 14), and cerebral VS category (n = 8).…”

Clinical characteristics and factors relating to poor outcome in patients with aneurysmal subarachnoid hemorrhage in Vietnam: A multicenter prospective cohort study

“…Additionally, patients with aneurysmal SAH who are discharged alive from the hospital have an increased long-term mortality rate compared with the general population [11][12][13][14][15]. Patients who are discharged alive from the hospital also have high rates of memory and neurocognitive impairment [16,17]. At three months after aneurysmal clipping, global impairment was present in approximately 20% of all patients who were discharged alive from the hospital and in 16% of those with excellent preoperative conditions [18].…”

Intracranial aneurysm wall (in)stability–current state of knowledge and clinical perspectives

“…The annual rupture rate of an IA is around 1%, inducing a prevalence of aneurysmal subarachnoid hemorrhage (SAH) of 9 to 100.000 inhabitants per year [49]. SAH is a devastating form of stroke associated with a high level of mortality (50%) and morbidity causing dependence (30-50%) [80]. As SAH affects mainly individuals 40 to 60 years old, its socioeconomic burden is heavy.…”