Prediction of 60-Day Case Fatality After Aneurysmal Subarachnoid Hemorrhage

Object. The purpose of this study was to assess the overall management and surgical outcome of primary intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (SAH) among the 85,000 residents of Izumo City, Japan.Methods. During 1991 through 1996, 267 patients with ICH and 123 with SAH were treated in Izumo. Of the 267 patients with ICH, 25 underwent hematoma removal by open craniotomy or suboccipital craniectomy and 34 underwent stereotactic evacuation of the hematoma, whereas aneurysm clipping was performed in 71 of the 123 patients with SAH; operability rates were thus 22% for ICH and 58% for SAH (p < 0.0001). The overall 30-day survival rates were 86% for ICH and 66% for SAH (p < 0.0001) and the 2-year survival rates were 73% and 62% (p = 0.0207), respectively. In patients who underwent surgery, 30-day and 2-year survival rates were 93% for ICH and 100% for SAH (p = 0.0262), and 75% for ICH and 97% for SAH (p = 0.0002), respectively. In patients with ICH, the most important predictors of 30-day case-fatality rates were the volume of the hematoma, the Glasgow Coma Scale (GCS) score, rebleeding, and midline shifting, whereas those for 2-year survival were the GCS score, age, rebleeding, and hematoma volume. In patients with SAH, the most important determinants of 30-day case-fatality rates were the GCS score and age, whereas only the GCS score had a significant impact on 2-year survival.Conclusions. The overall survival rates for patients with ICH or SAH in Izumo were more favorable than those in previously published epidemiological studies. However, despite improved surgical results, the overall management of ICH and SAH still produced an unsatisfactory outcome, mainly because of primary brain damage.

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Prediction of 60-day case fatality after aneurysmal subarachnoid hemorrhage: external validation of a prediction model

Critical Care ◽

10.1186/cc14547 ◽

2015 ◽

Vol 19 (Suppl 1) ◽

pp. P467

Author(s):

S Dijkland ◽

B Roozenbeek ◽

P Brouwer ◽

H Lingsma ◽

D Dippel ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Prediction Model ◽

Aneurysmal Subarachnoid Hemorrhage ◽

External Validation ◽

Case Fatality ◽

Day Case

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Aneurysmal subarachnoid hemorrhage: long-term trends in incidence and survival in Olmsted County, Minnesota

Journal of Neurosurgery ◽

10.3171/2019.12.jns192468 ◽

2020 ◽

pp. 1-6

Author(s):

Enrico Giordan ◽

Christopher S. Graffeo ◽

Alejandro A. Rabinstein ◽

Robert D. Brown ◽

Walter A. Rocca ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Incidence Rate ◽

Case Fatality Rate ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Fatality ◽

Population Based ◽

Fatality Rate ◽

Olmsted County ◽

Day Case ◽

Incident Cases

OBJECTIVERecent population-based and hospital cohort studies have reported a decreasing incidence of aneurysmal subarachnoid hemorrhage (aSAH) and declining aSAH-associated case-fatality rates. Principal drivers of these trends are debated, but improvements in smoking cessation and hypertension control may be critical factors.METHODSThe population-based medical records linkage system of the Rochester Epidemiological Project was used to document aSAH incidence and 30-day case fatality rates during a 20-year study period (1996–2016) in Olmsted County, Minnesota. Incidence rates in the study period were compared with data from a previous Olmsted County study concerning aSAH incidence from 1965 to 1995 and with regional trends in tobacco use.RESULTSOne hundred nineteen incident cases of aSAH were included. The median age at hemorrhage was 59 years (range 16–94 years), and 74 patients were female (62.2%). The overall average annual aSAH incidence rate was 4.2/100,000 person-years (P-Y). The aSAH incidence rate decreased from 5.7/100,000 in 1996 to 3.5/100,000 P-Y in 2011–2016. The overall aSAH-associated 30-day case-fatality rate was 21.9% and declined by approximately 0.5% annually. An accelerated decline in the fatality rate (0.9%/year) was observed from 2006–2016. Smoking among adult Olmsted County residents decreased from 20.4% in 2000 to 9.1% in 2018.CONCLUSIONSA decline in the incidence of aSAH and 30-day case-fatality rate from 1996 to 2016 was observed, as well as an accelerated decline of the fatality rate from 2006 to 2016. These findings confirm and extend the trends reported by prior studies in the same population. The decrease in aSAH in the years studied paralleled a noticeable reduction in the population smoking rates.

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Hospital case-volume is associated with case-fatality after aneurysmal subarachnoid hemorrhage

International Journal of Stroke ◽

10.1177/1747493018790073 ◽

2018 ◽

Vol 14 (3) ◽

pp. 282-289 ◽

Cited By ~ 2

Author(s):

Antti Lindgren ◽

Sarah Burt ◽

Ellie Bragan Turner ◽

Atte Meretoja ◽

Jin-Moo Lee ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Treatment Modality ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Tertiary Care ◽

Case Fatality ◽

High Volume ◽

Day Case ◽

Case Volume ◽

Hospital Case ◽

Low Volume

Background Inverse association between hospital case-volume and case-fatality has been observed for various nonsurgical interventions and surgical procedures. Aims To study the impact of hospital case-volume on outcome after aneurysmal subarachnoid hemorrhage (aSAH). Methods We included aSAH patients who underwent aneurysm coiling or clipping from tertiary care medical centers across three continents using the Dr Foster Stroke GOAL database 2007–2014. Hospitals were categorized by annual case-volume (low volume: <41/year; intermediate: 41–70/year; high: >70/year). Primary outcome was 14-day in-hospital case-fatality. We calculated proportions, and used multiple logistic regression to adjust for age, sex, differences in comorbidity or disease severity, aneurysm treatment modality, and hospital. Results We included 8525 patients (2363 treated in low volume hospitals, 3563 treated in intermediate volume hospitals, and 2599 in high-volume hospitals). Crude 14-day case-fatality for hospitals with low case-volume was 10.4% (95% confidence interval (CI) 9.2–11.7%), for intermediate volume 7.0% (95% CI 6.2–7.9%; adjusted odds ratio (OR) 0.63 (95%CI 0.47–0.85)) and for high volume 5.4% (95% CI 4.6–6.3%; adjusted OR 0.50 (95% CI 0.33–0.74)). In patients with clipped aneurysms, adjusted OR for 14-day case-fatality was 0.46 (95% CI 0.30–0.71) for hospitals with intermediate case-volume and 0.42 (95% CI 0.25–0.72) with high case-volume. In patients with coiled aneurysms, adjusted OR was 0.77 (95% CI 0.55–1.07) for hospitals with intermediate case-volume and 0.56 (95% CI 0.36–0.87) with high case-volume. Conclusions Even within a subset of large, tertiary care centers, intermediate and high hospital case-volume is associated with lower case-fatality after aSAH regardless of treatment modality, supporting centralization to higher volume centers.

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A Population-Based Study of the Incidence and Case Fatality of Non-aneurysmal Subarachnoid Hemorrhage

Neurocritical Care ◽

10.1007/s12028-014-0084-7 ◽

2014 ◽

Vol 22 (3) ◽

pp. 409-413 ◽

Cited By ~ 3

Author(s):

Adnan I. Qureshi ◽

Nauman Jahangir ◽

Mushtaq H. Qureshi ◽

Archie Defillo ◽

Ahmed A. Malik ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Fatality ◽

Population Based ◽

Population Based Study

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Incidence and case fatality of aneurysmal subarachnoid hemorrhage admitted to hospital between 2008 and 2014 in Norway

Acta Neurochirurgica ◽

10.1007/s00701-020-04463-x ◽

2020 ◽

Vol 162 (9) ◽

pp. 2251-2259 ◽

Cited By ~ 1

Author(s):

Lise R. Øie ◽

Ole Solheim ◽

Paulina Majewska ◽

Trond Nordseth ◽

Tomm B. Müller ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Fatality

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Abstract 185: Declining Subarachnoid Hemorrhage Case-Fatality Rates in a Population

Stroke ◽

10.1161/str.43.suppl_1.a185 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Jason Mackey ◽

Kathleen Alwell ◽

Jane C Khoury ◽

Charles J Moomaw ◽

Matthew L Flaherty ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Hospital Setting ◽

Case Fatality ◽

The United States ◽

Population Based ◽

Day Case ◽

Physician Review ◽

Time Period ◽

Medical Advances ◽

The Impact

Introduction: In the last few decades there have been several medical advances in the care of patients with subarachnoid hemorrhage (SAH). But few population-based studies (and none in the United States) have examined outcomes in the same population over time. Methods: All SAHs among residents of the Greater Cincinnati/Northern Kentucky (GCNK) region at least 20 years of age were identified using ICD-9 codes 430-436 and verified via study physician review in four distinct study periods. An incidence rate for each time period was calculated. Baseline characteristics, including demographics, risk factors, and functional status, were ascertained, along with hospital discharge modified Rankin score and all-cause 30- and 90-day case-fatality. Results: We identified 78 SAHs among residents of the GCNK region in 1988, 85 from 7/1993 to 6/1994, 95 in 1999, and 91 in 2005. The incidence of SAH in the four study periods (age-, race-, and sex-adjusted to the 2000 US population) was 9.4, 9.3, 10.0, and 9.0 per 100,000, respectively. Of the 349 SAHs in the study periods, 326 were diagnosed in an ED or hospital setting, while 23 were diagnosed on autopsy alone. All-cause 30- and 90-day case-fatality rates declined significantly from 1988 to 2005 ( Table ), even when all autopsy-alone cases were excluded. Conclusions: While the incidence of SAH remained stable in this population-based region, the 30-day and 90-day case-fatality rates declined significantly. Advances in surgical and medical management, along with systems-based changes such as the emergence of neurocritical care units, have likely led to reduced case-fatality. Future studies should explore the impact of specific factors related to improved case-fatality rates.

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Magnetic resonance imaging and brain injury in the chronic phase after aneurysmal subarachnoid hemorrhage: A systematic review

International Journal of Stroke ◽

10.1177/1747493017730781 ◽

2017 ◽

Vol 13 (1) ◽

pp. 24-34 ◽

Cited By ~ 2

Author(s):

Bertine L Stehouwer ◽

Lisa A van der Kleij ◽

Jeroen Hendrikse ◽

Gabriel JE Rinkel ◽

Jill B De Vis

Keyword(s):

Systematic Review ◽

Subarachnoid Hemorrhage ◽

Brain Volume ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Brain Mri ◽

Chronic Phase ◽

Case Fatality ◽

Intracranial Volume ◽

Level Of Evidence ◽

Brain Infarcts

Background Case-fatality rates after aneurysmal subarachnoid hemorrhage have decreased over the past decades. However, many patients who survive an aneurysmal subarachnoid hemorrhage have long-term functional and cognitive impairments. Aims We sought to review all data on conventional brain MRI obtained in the chronic phase after aneurysmal subarachnoid hemorrhage to (1) analyze the proportion of patients with cerebral infarction or brain volume changes; (2) investigate baseline determinants predictive of MRI-detected damage; and (3) assess if brain damage is predictive of patient outcome. Summary of review All original data published between 1 January 2000 and 4 October 2017 was searched using the PUBMED, EMBASE, and Web of Science databases. Based on preset inclusion criteria, 15 from 5200 articles were included with a total of 996 aneurysmal subarachnoid hemorrhage patients. Quality assessment, risk of bias assessment, and level of evidence assessment were performed. The results according to aim, with levels of evidence, were: (1) 25 to 81% of aneurysmal subarachnoid hemorrhage patients show infarcts (strong); there is a higher ratio of cerebrospinal fluid-to-intracranial volume in patients compared to controls (strong); (2) there is a negative relation between age (moderate), DCI (low) and brain volume measurement outcomes; (3) lower brain parenchymal volume (strong) and the presence of infarcts or infarct volumes (moderate) are associated with a worse outcome. Conclusion Patients after aneurysmal subarachnoid hemorrhage may demonstrate brain infarcts and decreased brain parenchyma, which is related to worse outcome. Thereby, both brain infarcts and brain volume measurements could be used as outcome markers in pharmaceutical trials. Systematic Review Registration PROSPERO CRD42016040095

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