Increased mortality of patients with aneurysmatic subarachnoid hemorrhage caused by prolonged transport time to a high-volume neurosurgical unit

Aneurysmal Subarachnoid Hemorrhage

“…Acute SAH is a life-threatening condition that is often incorrectly diagnosed at first, despite its characteristic clinical presentation; precise figures on misdiagnosed SAH are unavailable (23). Attention must be paid to meningismus, a common accompaniment of SAH.…”

“…The management of patients with acute SAH in the period before the source of the bleeding has been secured is aimed at preventing lifethreatening complications and second bleeds, and thereby minimizing further damage to the brain (Figure 1, Table 2). Second bleeds in the first 24 hours often arise in association with transport and medical interventions; it is nonetheless clear that patients whose consciousness is impaired should be transferred to a neurovascular center as soon as possible, because any delay worsens the prognosis (23). All patients with acute SAH should immediately be taken to such a center (i.e., a hospital where specialized units for neurosurgery, neurology, and neuroradiology are present and have experience treating patients with aneurysmal SAH).…”

“…All patients with acute SAH should immediately be taken to such a center (i.e., a hospital where specialized units for neurosurgery, neurology, and neuroradiology are present and have experience treating patients with aneurysmal SAH). Lieshout et al showed in 2016 that delayed transport to a neurosurgical center, with prolongation of the interval from the onset of SAH to arrival in the center, significantly worsens mortality (23). Delayed transport is often accounted for by initial presentation to a hospital without a neurosurgical service, or else by an initial misdiagnosis (23).…”

“…Lieshout et al showed in 2016 that delayed transport to a neurosurgical center, with prolongation of the interval from the onset of SAH to arrival in the center, significantly worsens mortality (23). Delayed transport is often accounted for by initial presentation to a hospital without a neurosurgical service, or else by an initial misdiagnosis (23). Patients with acute SAH initially misdiagnosed as suffering from coronary heart disease (CHD) suffered up to 75% mortality because of the time wasted in ruling out CHD (23).…”

“…Delayed transport is often accounted for by initial presentation to a hospital without a neurosurgical service, or else by an initial misdiagnosis (23). Patients with acute SAH initially misdiagnosed as suffering from coronary heart disease (CHD) suffered up to 75% mortality because of the time wasted in ruling out CHD (23). Until the aneurysm has been secured by clipping or coiling, the patient's vital signs must be continuously monitored (with continuous recording of blood pressure and, in some cases, ECG), and the neurological status must be documented at close intervals as well (state of consciousness, Glasgow Coma Scale, pupillary responses, and any focal neurologic deficits).…”