Functional Outcome After Poor-Grade Subarachnoid Hemorrhage: A Single-Center Study and Systematic Literature Review

Background and Purpose Poor-grade subarachnoid hemorrhage (SAH) (World Federation of Neurosurgical Societies grade 4 and 5) is associated with high mortality rates and unfavorable functional outcomes. We report a single-center cohort of poor-grade SAH patients, combined with a systematic review of s...

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Published in:	Neurocritical care 2016-12, Vol.25 (3), p.338-350
Main Authors:	de Oliveira Manoel, Airton Leonardo, Mansur, Ann, Silva, Gisele Sampaio, Germans, Menno R., Jaja, Blessing N. R., Kouzmina, Ekaterina, Marotta, Thomas R., Abrahamson, Simon, Schweizer, Tom A., Spears, Julian, Macdonald, R. Loch
Format:	Article
Language:	eng
Subjects:	Adult Aged Aneurysms Coma Critical Care Medicine Female Hematoma Hemorrhage Humans Intensive Internal Medicine Literature reviews Magnetic resonance imaging Male Medical imaging Medicine Medicine & Public Health Middle Aged Mortality Neurology Original Article Outcome Assessment (Health Care) Patients Prognosis Retrospective Studies Severity of Illness Index Stroke Subarachnoid Hemorrhage - mortality Subarachnoid Hemorrhage - therapy Surveillance Systematic review Tomography
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Summary:	Background and Purpose Poor-grade subarachnoid hemorrhage (SAH) (World Federation of Neurosurgical Societies grade 4 and 5) is associated with high mortality rates and unfavorable functional outcomes. We report a single-center cohort of poor-grade SAH patients, combined with a systematic review of studies reporting functional outcome in the poor-grade SAH population. Methods Data on a cohort of poor-grade SAH patients treated between 2009 and 2013 were retrospectively collected and combined with a systematic review (from inception to November 2015; PubMed, Embase). Two reviewers assessed the studies independently based on predefined inclusion criteria: consecutive poor-grade SAH, functional outcome measured at least 3 months after hemorrhage, and the report of patients who died before aneurysm treatment. Results The search yielded 329 publications, and 23 met our inclusion criteria with 2713 subjects enrolled from 1977 to 2014 in 10 countries (including 179 poor-grade patients from our cohort). Mortality rate was 60 % (1683 patients), of which 806 (29 %) died before and 877 (31 %) died after aneurysm treatment, respectively. Treatment was undertaken in 1775 patients (1775/2826—63 %): 1347 by surgical clipping (1347/1775—76 %) and 428 (428/1775—24 %) by endovascular methods. Outcome was favorable in 794 patients (28 %) and unfavorable in 1867 (66 %). When the studies were grouped into decades, favorable outcome increased from 13 % in the late 1970s to early 1980s to 35 % in the late 1980s to early 1990s, and remained unchanged thereafter. Conclusion Although mortality remains high in poor-grade SAH patients, a favorable functional outcome can be achieved in approximately one-third of patients. The development of new diagnostic methods and implementation of therapeutic approaches were probably responsible for the decrease in mortality and improvement in the functional outcome from 1970 to the 1990s. The plateau in functional outcome seen thereafter might be explained by the treatment of sicker and older patients and by the lack of new therapeutic interventions specific for SAH.
ISSN:	1541-6933 1556-0961