Update on subarachnoid haemorrhage

Ferro, José M.; Canhão, Patrı́cia; Peralta, Ana Rita

doi:10.1007/s00415-008-0606-3

Cited by 60 publications

(43 citation statements)

References 109 publications

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“…1 About a quarter of patients with SAH will die within 2 weeks of hospital admission, and a similar proportion of survivors are discharged with functional disabilities that may require prolonged institutional care for recovery to premorbid lifestyle. 2 Socioeconomic status (SES) has been shown to have a significant impact on cerebrovascular and cardiovascular disease outcomes; the factors mediating this effect, to a large extent, are unknown. 3,4 At least 2 reviews have been published to synthesize the current evidence on the association with regard to stroke, but with very little or no information available on SAH.…”

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confidence: 99%

Effect of Socioeconomic Status on Inpatient Mortality and Use of Postacute Care After Subarachnoid Hemorrhage

Jaja

Saposnik

Nisenbaum

et al. 2013

Stroke

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Background and Purpose-Studies in the United States and Canada have demonstrated socioeconomic gradients in outcomes of acute life-threatening cardiovascular and cerebrovascular diseases. The extent to which these findings are applicable to subarachnoid hemorrhage is uncertain. This study investigated socioeconomic status-related differences in risk of inpatient mortality and use of institutional postacute care after subarachnoid hemorrhage in the United States and Canada. Methods-Subarachnoid hemorrhage patient records in the US Nationwide Inpatient Sample database (2005)(2006)(2007)(2008)(2009)(2010) and the Canadian Discharge Abstract Database (2004Database ( -2010 were analyzed separately, and summative results were compared. Both databases are nationally representative and contain relevant sociodemographic, diagnostic, procedural, and administrative information. We determined socioeconomic status on the basis of estimated median household income of residents for patient's ZIP or postal code. Multinomial logistic regression models were fitted with adjustment for relevant confounding covariates. Results-The cohort consisted of 31 631 US patients and 16 531 Canadian patients. Mean age (58 years) and crude inpatient mortality rates (22%) were similar in both countries. A significant income-mortality association was observed among US patients (odds ratio, 0.77; 95% CI, 0.65-0.93), which was absent among Canadian patients (odds ratio, 0.97; 95% CI, 0.85-1.12). Neighborhood income status was not significantly associated with use of postacute care in the 2 countries. Conclusions-Socioeconomic status is associated with subarachnoid hemorrhage inpatient mortality risk in the UnitedStates, but not in Canada, although it does not influence the pattern of use of institutional care among survivors in both countries.

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confidence: 99%

Effect of Socioeconomic Status on Inpatient Mortality and Use of Postacute Care After Subarachnoid Hemorrhage

Jaja

Saposnik

Nisenbaum

et al. 2013

Stroke

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“…About 12–15% of patients die before hospital admission, and a further 30–45% die during the following days [2]. In addition, rates of sequelae are also high [3]. …”

Section: Introductionmentioning

confidence: 99%

Early Endovascular Treatment of Subarachnoid Hemorrhage

Matías‐Guiu

Serna-Candel

2012

Intervent Neurol

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Subarachnoid hemorrhage is an important cause of morbidity and mortality. Rebleeding is one of its major complications, which occurs mainly within the first 24 h and worsens the clinical outcome in a very dramatic way. It may be prevented by aneurysm treatment: surgical clipping or endovascular coiling. We review the evidence of and recent advances in endovascular treatment and timing of the intervention. Data supporting the benefit of early (<72 h) and ultra-early (<24 h) treatment is based on observational studies. An earlier approach may be relevant for the prevention of rebleeding and improvement of clinical outcome, but several disadvantages should be considered, such as an increased rate of periprocedural complications. Hence, a well-designed randomized controlled trial deems necessary to be able to define the optimal time of treatment. The possibility of treatment concomitant with the initial angiography should also be taken into account in this trial. This fact might represent a benefit favoring coiling over clipping in the prevention of rebleeding, and thus avoiding the inevitable delay necessary for the preparation for surgery.

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“…35 Globally, mortality in patients with spontaneous SAH ranges from 32% to 67% and has been reported to be as high as 42% in patients with spontaneous ICH. 32,33,36,37 For patients with severe grades of these diseases (SAH Hunt & Hess Ն3 and ICH GCS Յ10), the observed neuro-ICU mortality was much lower, being 20% (SAH) and 16% (ICH) (35% vs 27% at 6-month follow-up) in the CoolGard and conventional groups, respectively. Therefore, an additional reduction in mortality in the neuro-ICU in this study by means of normothermia seems even more difficult to achieve.…”

Section: Neurologic Functional Outcomementioning

confidence: 95%

Prophylactic, Endovascularly Based, Long-Term Normothermia in ICU Patients With Severe Cerebrovascular Disease

Broessner

Beer

Lackner

et al. 2009

Stroke

110

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Background and Purpose— We sought to study the effectiveness and safety of endovascular cooling to maintain prophylactic normothermia in comparison with standardized, stepwise, escalating fever management to reduce fever burden in patients with severe cerebrovascular disease. Methods— This study was a prospective, randomized, controlled trial with a blinded neurologic outcome evaluation comparison between prophylactic, catheter-based normothermia (CoolGard; ie, body core temperature 36.5°C) and conventional, stepwise fever management with anti-inflammatory drugs and surface cooling. Patients admitted to 1 of the 2 neurointensive care units were eligible for study inclusion when they had a (1) spontaneous subarachnoid hemorrhage with Hunt & Hess grade between 3 and 5, (2) spontaneous intracerebral hemorrhage with a Glasgow Coma Scale score ≤10, or (3) complicated cerebral infarction requiring intensive care unit treatment with a National Institutes of Health Stroke Scale score ≥15. Results— A total of 102 patients (56 female) were enrolled during a 3.5-year period. Fifty percent had a spontaneous subarachnoid hemorrhage, 40% had a spontaneous intracerebral hemorrhage, and 10% had a complicated cerebral infarction. Overall median total fever burden during the course of treatment was 0.0°C hour and 4.3°C hours in the catheter and conventional groups, respectively ( P <0.0001). Prophylactic normothermia did not lead to an increase in the number of patients who experienced a major adverse event. No significant difference was found in mortality and neurologic long-term follow-up. Conclusions— Long-term, catheter-based, prophylactic normothermia significantly reduces fever burden in neurointensive care unit patients with severe cerebrovascular disease and is not associated with increased major adverse events.

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Update on subarachnoid haemorrhage

Cited by 60 publications

References 109 publications

Effect of Socioeconomic Status on Inpatient Mortality and Use of Postacute Care After Subarachnoid Hemorrhage

Effect of Socioeconomic Status on Inpatient Mortality and Use of Postacute Care After Subarachnoid Hemorrhage

Early Endovascular Treatment of Subarachnoid Hemorrhage

Prophylactic, Endovascularly Based, Long-Term Normothermia in ICU Patients With Severe Cerebrovascular Disease

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