Abstract
The medical charts of 801 consecutive patients transferred to our critical care center over a 14-year interval (1994-2007) in poor neurological condition (World Federation of Neurological Surgeons; WFNS grade IV or V) after subarachnoid hemorrhage (SAH) were retrospectively analyzed. All patients were treated following a strict protocol. After initial neurological evaluation, patients were sedated, paralyzed, and underwent strict blood pressure control. For patients with WFNS grade IV and selected patients with grade V, aggressive ultra-early repair (mainly clipping for anterior circulation aneurysm, coiling for posterior circulation aneurysm) was initiated. In grade V patients with poor brainstem function or destruction of vital brain areas on CT, only comfort measures were offered. Compared to the former period (1994-2000), coiling was more frequently indicated in elderly patients and bypass surgery was more often applied in complex aneurysm cases in the latter period (2001-2007). Compared to the former period, the number of aggressively treated patients significantly increased (37.6% versus 28.8%) in the latter period. Outcome assessments performed at 3 months revealed a significant increase of favorable outcomes (Glasgow Outcome Scale; good recovery (GR) or moderately disabled (MD)) and a decreased mortality rate in those patients (34% versus 28%, and 43% versus 47%; respectively). The
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Kurita, Hiroki;
Sato, Eishi;
Shiokawa, Yoshiaki
[1]
- Kyorin Univ., Faculty of Medicine, Mitaka, Tokyo (Japan)
Citation Formats
Kurita, Hiroki, Sato, Eishi, and Shiokawa, Yoshiaki.
Treatment strategy, management and clinical outcome of patients with poor-grade subarachnoid hemorrhage.
Japan: N. p.,
2010.
Web.
Kurita, Hiroki, Sato, Eishi, & Shiokawa, Yoshiaki.
Treatment strategy, management and clinical outcome of patients with poor-grade subarachnoid hemorrhage.
Japan.
Kurita, Hiroki, Sato, Eishi, and Shiokawa, Yoshiaki.
2010.
"Treatment strategy, management and clinical outcome of patients with poor-grade subarachnoid hemorrhage."
Japan.
@misc{etde_21324210,
title = {Treatment strategy, management and clinical outcome of patients with poor-grade subarachnoid hemorrhage}
author = {Kurita, Hiroki, Sato, Eishi, and Shiokawa, Yoshiaki}
abstractNote = {The medical charts of 801 consecutive patients transferred to our critical care center over a 14-year interval (1994-2007) in poor neurological condition (World Federation of Neurological Surgeons; WFNS grade IV or V) after subarachnoid hemorrhage (SAH) were retrospectively analyzed. All patients were treated following a strict protocol. After initial neurological evaluation, patients were sedated, paralyzed, and underwent strict blood pressure control. For patients with WFNS grade IV and selected patients with grade V, aggressive ultra-early repair (mainly clipping for anterior circulation aneurysm, coiling for posterior circulation aneurysm) was initiated. In grade V patients with poor brainstem function or destruction of vital brain areas on CT, only comfort measures were offered. Compared to the former period (1994-2000), coiling was more frequently indicated in elderly patients and bypass surgery was more often applied in complex aneurysm cases in the latter period (2001-2007). Compared to the former period, the number of aggressively treated patients significantly increased (37.6% versus 28.8%) in the latter period. Outcome assessments performed at 3 months revealed a significant increase of favorable outcomes (Glasgow Outcome Scale; good recovery (GR) or moderately disabled (MD)) and a decreased mortality rate in those patients (34% versus 28%, and 43% versus 47%; respectively). The ratio of favorable outcome and morbidity in all admitted patients were also improved (12% versus 8%, and 79% versus 85%; respectively). Outcome was largely determined by the initial hemorrhage and subsequent development of intractable intracranial hypertension or cerebral infraction. Age was also found to be significantly correlated with outcome. There was no significant difference in outcomes by treatment modality (clip or coil). In the latter period, aneurismal location was not the predictor, but delayed ischemic neurological deficit (DIND) remained an important factor. In conclusion, the overall outcome of poor-grade SAH patients has recently improved owing to the expanding indication of aggressive treatment. Our policy does not lead to a large number of dependent survivors, even among elderly poor-grade patients. Adequate management of vasospasm is warranted to improve overall outcome of those patients. (author)}
journal = []
issue = {2}
volume = {19}
place = {Japan}
year = {2010}
month = {Feb}
}
title = {Treatment strategy, management and clinical outcome of patients with poor-grade subarachnoid hemorrhage}
author = {Kurita, Hiroki, Sato, Eishi, and Shiokawa, Yoshiaki}
abstractNote = {The medical charts of 801 consecutive patients transferred to our critical care center over a 14-year interval (1994-2007) in poor neurological condition (World Federation of Neurological Surgeons; WFNS grade IV or V) after subarachnoid hemorrhage (SAH) were retrospectively analyzed. All patients were treated following a strict protocol. After initial neurological evaluation, patients were sedated, paralyzed, and underwent strict blood pressure control. For patients with WFNS grade IV and selected patients with grade V, aggressive ultra-early repair (mainly clipping for anterior circulation aneurysm, coiling for posterior circulation aneurysm) was initiated. In grade V patients with poor brainstem function or destruction of vital brain areas on CT, only comfort measures were offered. Compared to the former period (1994-2000), coiling was more frequently indicated in elderly patients and bypass surgery was more often applied in complex aneurysm cases in the latter period (2001-2007). Compared to the former period, the number of aggressively treated patients significantly increased (37.6% versus 28.8%) in the latter period. Outcome assessments performed at 3 months revealed a significant increase of favorable outcomes (Glasgow Outcome Scale; good recovery (GR) or moderately disabled (MD)) and a decreased mortality rate in those patients (34% versus 28%, and 43% versus 47%; respectively). The ratio of favorable outcome and morbidity in all admitted patients were also improved (12% versus 8%, and 79% versus 85%; respectively). Outcome was largely determined by the initial hemorrhage and subsequent development of intractable intracranial hypertension or cerebral infraction. Age was also found to be significantly correlated with outcome. There was no significant difference in outcomes by treatment modality (clip or coil). In the latter period, aneurismal location was not the predictor, but delayed ischemic neurological deficit (DIND) remained an important factor. In conclusion, the overall outcome of poor-grade SAH patients has recently improved owing to the expanding indication of aggressive treatment. Our policy does not lead to a large number of dependent survivors, even among elderly poor-grade patients. Adequate management of vasospasm is warranted to improve overall outcome of those patients. (author)}
journal = []
issue = {2}
volume = {19}
place = {Japan}
year = {2010}
month = {Feb}
}