Early Treatment Decisions in Poor-Grade Patients with Subarachnoid Hemorrhage

Jantien Hoogmoed, Bert A. Coert, René van den Berg, Yvo B.W.E.M. Roos, Janneke Horn, W. Peter Vandertop, Dagmar Verbaan

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Patients with World Federation of Neurosurgical Societies (WFNS) grade V subarachnoid hemorrhage (SAH) mostly have a poor outcome. Correct identification of patients who might benefit from treatment remains challenging. We investigated which disease-related characteristics, present at admission, could identify patients with chance of good outcome. Methods: In total, 146 consecutive patients with WFNS grade V SAH (2002–2013) were included. Demographic and disease-related characteristics were compared between patients with a good outcome (Glasgow Outcome Scale 4 and 5) and a poor outcome (Glasgow Outcome Scale 1-3). Subgroups were made of patients with aneurysm treatment according to outcome; 1) good outcome; 2) poor outcome, with optimal general treatment; and 3) poor outcome, general treatment discontinued. Results: In total, 34 of the 146 patients had a good outcome (36% of all treated patients); 16 (47%) of these presented with a Glasgow Coma Scale score of 3, versus 65 (58%) of patients with a poor outcome (P = 0.33). Eleven (33%) patients in the good outcome group presented with pupillary abnormalities; 4 (12%) even had bilaterally fixed and dilated pupils, versus 49 (46%) in patients with a poor outcome (P < 0.01). In 51 patients, the aneurysm was not treated; all died. Conclusions: More than one third of all treated patients with WFNS grade V SAH had a good outcome. All patients in whom the aneurysm was not treated died. Reliable identification of patients who will reach good outcome, on the basis of symptoms on admission, seems impossible, as these symptoms are not discriminating enough.

Original languageEnglish
Pages (from-to)e568-e573
JournalWorld Neurosurgery
Volume119
DOIs
Publication statusPublished - 1 Nov 2018

Cite this

Hoogmoed, Jantien ; Coert, Bert A. ; van den Berg, René ; Roos, Yvo B.W.E.M. ; Horn, Janneke ; Vandertop, W. Peter ; Verbaan, Dagmar. / Early Treatment Decisions in Poor-Grade Patients with Subarachnoid Hemorrhage. In: World Neurosurgery. 2018 ; Vol. 119. pp. e568-e573.
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title = "Early Treatment Decisions in Poor-Grade Patients with Subarachnoid Hemorrhage",
abstract = "Background: Patients with World Federation of Neurosurgical Societies (WFNS) grade V subarachnoid hemorrhage (SAH) mostly have a poor outcome. Correct identification of patients who might benefit from treatment remains challenging. We investigated which disease-related characteristics, present at admission, could identify patients with chance of good outcome. Methods: In total, 146 consecutive patients with WFNS grade V SAH (2002–2013) were included. Demographic and disease-related characteristics were compared between patients with a good outcome (Glasgow Outcome Scale 4 and 5) and a poor outcome (Glasgow Outcome Scale 1-3). Subgroups were made of patients with aneurysm treatment according to outcome; 1) good outcome; 2) poor outcome, with optimal general treatment; and 3) poor outcome, general treatment discontinued. Results: In total, 34 of the 146 patients had a good outcome (36{\%} of all treated patients); 16 (47{\%}) of these presented with a Glasgow Coma Scale score of 3, versus 65 (58{\%}) of patients with a poor outcome (P = 0.33). Eleven (33{\%}) patients in the good outcome group presented with pupillary abnormalities; 4 (12{\%}) even had bilaterally fixed and dilated pupils, versus 49 (46{\%}) in patients with a poor outcome (P < 0.01). In 51 patients, the aneurysm was not treated; all died. Conclusions: More than one third of all treated patients with WFNS grade V SAH had a good outcome. All patients in whom the aneurysm was not treated died. Reliable identification of patients who will reach good outcome, on the basis of symptoms on admission, seems impossible, as these symptoms are not discriminating enough.",
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author = "Jantien Hoogmoed and Coert, {Bert A.} and {van den Berg}, Ren{\'e} and Roos, {Yvo B.W.E.M.} and Janneke Horn and Vandertop, {W. Peter} and Dagmar Verbaan",
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Early Treatment Decisions in Poor-Grade Patients with Subarachnoid Hemorrhage. / Hoogmoed, Jantien; Coert, Bert A.; van den Berg, René; Roos, Yvo B.W.E.M.; Horn, Janneke; Vandertop, W. Peter; Verbaan, Dagmar.

In: World Neurosurgery, Vol. 119, 01.11.2018, p. e568-e573.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Early Treatment Decisions in Poor-Grade Patients with Subarachnoid Hemorrhage

AU - Hoogmoed, Jantien

AU - Coert, Bert A.

AU - van den Berg, René

AU - Roos, Yvo B.W.E.M.

AU - Horn, Janneke

AU - Vandertop, W. Peter

AU - Verbaan, Dagmar

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: Patients with World Federation of Neurosurgical Societies (WFNS) grade V subarachnoid hemorrhage (SAH) mostly have a poor outcome. Correct identification of patients who might benefit from treatment remains challenging. We investigated which disease-related characteristics, present at admission, could identify patients with chance of good outcome. Methods: In total, 146 consecutive patients with WFNS grade V SAH (2002–2013) were included. Demographic and disease-related characteristics were compared between patients with a good outcome (Glasgow Outcome Scale 4 and 5) and a poor outcome (Glasgow Outcome Scale 1-3). Subgroups were made of patients with aneurysm treatment according to outcome; 1) good outcome; 2) poor outcome, with optimal general treatment; and 3) poor outcome, general treatment discontinued. Results: In total, 34 of the 146 patients had a good outcome (36% of all treated patients); 16 (47%) of these presented with a Glasgow Coma Scale score of 3, versus 65 (58%) of patients with a poor outcome (P = 0.33). Eleven (33%) patients in the good outcome group presented with pupillary abnormalities; 4 (12%) even had bilaterally fixed and dilated pupils, versus 49 (46%) in patients with a poor outcome (P < 0.01). In 51 patients, the aneurysm was not treated; all died. Conclusions: More than one third of all treated patients with WFNS grade V SAH had a good outcome. All patients in whom the aneurysm was not treated died. Reliable identification of patients who will reach good outcome, on the basis of symptoms on admission, seems impossible, as these symptoms are not discriminating enough.

AB - Background: Patients with World Federation of Neurosurgical Societies (WFNS) grade V subarachnoid hemorrhage (SAH) mostly have a poor outcome. Correct identification of patients who might benefit from treatment remains challenging. We investigated which disease-related characteristics, present at admission, could identify patients with chance of good outcome. Methods: In total, 146 consecutive patients with WFNS grade V SAH (2002–2013) were included. Demographic and disease-related characteristics were compared between patients with a good outcome (Glasgow Outcome Scale 4 and 5) and a poor outcome (Glasgow Outcome Scale 1-3). Subgroups were made of patients with aneurysm treatment according to outcome; 1) good outcome; 2) poor outcome, with optimal general treatment; and 3) poor outcome, general treatment discontinued. Results: In total, 34 of the 146 patients had a good outcome (36% of all treated patients); 16 (47%) of these presented with a Glasgow Coma Scale score of 3, versus 65 (58%) of patients with a poor outcome (P = 0.33). Eleven (33%) patients in the good outcome group presented with pupillary abnormalities; 4 (12%) even had bilaterally fixed and dilated pupils, versus 49 (46%) in patients with a poor outcome (P < 0.01). In 51 patients, the aneurysm was not treated; all died. Conclusions: More than one third of all treated patients with WFNS grade V SAH had a good outcome. All patients in whom the aneurysm was not treated died. Reliable identification of patients who will reach good outcome, on the basis of symptoms on admission, seems impossible, as these symptoms are not discriminating enough.

KW - Aneurysm

KW - Coma

KW - Subarachnoid hemorrhage

KW - Treatment

KW - Withholding treatment

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U2 - 10.1016/j.wneu.2018.07.212

DO - 10.1016/j.wneu.2018.07.212

M3 - Article

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SP - e568-e573

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JF - World Neurosurgery

SN - 1878-8750

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