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Kidani N, Sugiu K, Terasaka K, Nakashima H, Tokunaga K, Kobayashi K, Kambara H, Hishikawa T, Hiramatsu M, Date I. Mobile endovascular therapy for acute treatment of ruptured vertebral artery dissecting aneurysm in multiple hospitals. Acta Neurochir (Wien) 2022; 164:517-523. [PMID: 34146152 DOI: 10.1007/s00701-021-04885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The patients with ruptured vertebral artery dissecting aneurysm (rVADA) should be treated as early as possible because VADA carries extremely high risk of rebleeding in the acute phase. We have established a mobile endovascular strategy for the patients with rVADA between our flagship center and its affiliated local hospitals. We introduced and reviewed our mobile endovascular therapy in this study. METHODS We retrospectively evaluated 98 consecutive patients who underwent endovascular surgery for rVADA from 2000 to 2018 at our institution or five affiliated hospitals. When each patient was initially transported to the local affiliated hospitals, neuroendovascular surgeons traveled directly to the affiliated hospital from the flagship center in order to treat the patient there. Clinical outcomes using modified Rankin Scale at 6 months after treatment, radiological results, and procedure-related complications were reviewed to justify our mobile endovascular strategy. RESULTS All aneurysms were cured successfully by internal trapping. Favorable outcome was achieved in 61 patients (62.2%) even though 53 patients (54.1%) had presented with severe subarachnoid hemorrhage. Overall mortality rate, treatment-related mortality rate, and treatment related complication rate were 18.4% (18/98), 0%, and 16% (16/98), respectively. There were no differences in clinical and radiological outcomes between the patients treated in the flagship center and those who treated in the affiliated hospitals. Treatment in the affiliated hospital was not a predictive factor of unfavorable outcome in our multivariate analysis, and elderly age (≥ 60) was negatively associated with favorable outcome. CONCLUSIONS Our results prove the efficacy and safety of mobile endovascular therapy for the treatment of rVADA in the ultra-acute stage. Mobile endovascular therapy may work well in the acute treatment of rVADAs in the certain circumstance.
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Affiliation(s)
- Naoya Kidani
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Kenji Sugiu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan.
| | - Kaoru Terasaka
- Department of Neurosurgery, Kure Kyosai Hospital, Kure, Hiroshima, Japan
| | | | - Koji Tokunaga
- Department of Neurosurgery, Okayama City Municipal Hospital, Okayama, Japan
| | - Kazuki Kobayashi
- Department of Neurosurgery, Tsuyama Chuo Hospital, Tsuyama, Okayama, Japan
| | - Hirokazu Kambara
- Department of Neurosurgery, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Masafumi Hiramatsu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
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Chan KYT, Yong ASM, Wang X, Ringgold KM, St John AE, Baylis JR, White NJ, Kastrup CJ. The adhesion of clots in wounds contributes to hemostasis and can be enhanced by coagulation factor XIII. Sci Rep 2020; 10:20116. [PMID: 33208779 PMCID: PMC7675984 DOI: 10.1038/s41598-020-76782-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/18/2020] [Indexed: 11/09/2022] Open
Abstract
The adhesion of blood clots to wounds is necessary to seal injured vasculature and achieve hemostasis. However, it has not been specifically tested if adhesive failure of clots is a major contributor to rebleeding and what mechanisms prevent clot delamination. Here, we quantified the contribution of adhesive and cohesive failure to rebleeding in a rat model of femoral artery injury, and identified mechanisms that contribute to the adhesive strength of bulk clots in a lap-shear test in vitro. In the rat bleeding model, the frequency of clot failures correlated positively with blood loss (R = 0.81, p = 0.014) and negatively with survival time (R = - 0.89, p = 0.0030), with adhesive failures accounting for 51 ± 14% of rebleeds. In vitro, adhesion depended on fibrinogen and coagulation factor XIII (FXIII), and supraphysiological FXIII improved adhesive strength. Furthermore, when exogenous FXIII was topically applied into the wound pocket of rats, eleven adhesive failures occurred between eight rats, compared to seventeen adhesive failures between eight untreated rats, whereas the number of cohesive failures remained the same at sixteen in both groups. In conclusion, rebleeding from both adhesive and cohesive failure of clots decreases survival from hemorrhage in vivo. Both endogenous and exogenous FXIII improves the adhesive strength of clots.
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Affiliation(s)
- Karen Y T Chan
- Michael Smith Laboratories, University of British Columbia, 2185 East Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Alyssa S M Yong
- Michael Smith Laboratories, University of British Columbia, 2185 East Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Xu Wang
- Department of Emergency Medicine, University of Washington, Seattle, USA
| | - Kristyn M Ringgold
- Department of Emergency Medicine, University of Washington, Seattle, USA
| | | | - James R Baylis
- Michael Smith Laboratories, University of British Columbia, 2185 East Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Nathan J White
- Department of Emergency Medicine, University of Washington, Seattle, USA
| | - Christian J Kastrup
- Michael Smith Laboratories, University of British Columbia, 2185 East Mall, Vancouver, BC, V6T 1Z4, Canada.
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Weyhenmeyer J, Guandique CF, Leibold A, Lehnert S, Parish J, Han W, Tuchek C, Pandya J, Leipzig T, Payner T, DeNardo A, Scott J, Cohen-Gadol AA. Effects of distance and transport method on intervention and mortality in aneurysmal subarachnoid hemorrhage. J Neurosurg 2017; 128:490-498. [PMID: 28186453 DOI: 10.3171/2016.9.jns16668] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Most patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) initially present to a hospital that lacks a neurosurgical unit. These patients require interhospital transfer (IHT) to tertiary facilities capable of multidisciplinary neurosurgical intervention. Yet, little is known about the effects of IHT on the outcomes of patients suffering from aSAH. In this study, the authors examined the effects of IHT and transport method on the timing of treatment, rebleed rates, and overall outcomes of patients who have experienced aSAH. METHODS A retrospective review of medical records identified all consecutive patients who presented with aSAH at an outside hospital and subsequently underwent IHT to a tertiary aneurysm care center and patients who initially presented directly to a tertiary aneurysm care facility between 2008 and 2015. Demographic, operative, radiological, hospital of initial evaluation, transfer method, and outcome data were retrospectively collected. RESULTS The authors identified 763 consecutive patients who were evaluated for aSAH at a tertiary aneurysm care facility either directly or following IHT. For patients who underwent IHT and after accounting for these patients' clinical variability and dichotomizing the patients into groups transferred less than 20 miles and more than 20 miles, the authors noted a significant increase in mortality rates: 7% (< 20 miles) and 18.8% (> 20 miles) (p = 0.004). The increased mortality rate was partially explained by an increased rate of initial presentation to an accredited stroke center in patients undergoing IHT of less than 20 miles (p = 0.000). The method of transport (ground or air ambulance) was found to have significant effect on the patients' outcomes as measured by the Glasgow Outcome Scale score (p = 0.021); patients who underwent ground transport demonstrated a higher likelihood of discharge to home (p = 0.004). The increased severity of presentation in the patient cohort undergoing IHT by air as defined by the Glasgow Coma Scale score, a need for an external ventricular drain, Hunt and Hess grade, and intubation status at presentation did not result in increased mortality when compared with the ground cohort (p = 0.074). In addition, there was an 8-hour increase in duration of time from admission to treatment for the air cohort as compared with the ground cohort (p = 0.054), indicating a potential for further improvement in the overall outcome of this patient group. CONCLUSIONS Aneurysmal SAH remains a challenging neurosurgical disease process requiring highly coordinated care in tertiary referral centers. In this study, the overall distance traveled and the transport method affected patient outcomes. The time from admission to treatment should continue to improve. Further analysis of IHT with a focus on patient monitoring and treatment during transport is warranted.
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Affiliation(s)
- Jonathan Weyhenmeyer
- 1Goodman Campbell Brain and Spine and Department of Neurosurgery, Indiana University, Indianapolis
| | | | - Adam Leibold
- 2Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Stephen Lehnert
- 2Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Jonathan Parish
- 3Carolina's Medical Center Department of Neurosurgery, Charlotte, North Carolina
| | - Woody Han
- 2Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Chad Tuchek
- 2Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Janit Pandya
- 2Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Thomas Leipzig
- 1Goodman Campbell Brain and Spine and Department of Neurosurgery, Indiana University, Indianapolis
| | - Troy Payner
- 1Goodman Campbell Brain and Spine and Department of Neurosurgery, Indiana University, Indianapolis
| | - Andrew DeNardo
- 1Goodman Campbell Brain and Spine and Department of Neurosurgery, Indiana University, Indianapolis
| | - John Scott
- 1Goodman Campbell Brain and Spine and Department of Neurosurgery, Indiana University, Indianapolis
| | - Aaron A Cohen-Gadol
- 1Goodman Campbell Brain and Spine and Department of Neurosurgery, Indiana University, Indianapolis
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Solanki C, Pandey P, Rao KVLN. Predictors of aneurysmal rebleed before definitive surgical or endovascular management. Acta Neurochir (Wien) 2016; 158:1037-44. [PMID: 27068042 DOI: 10.1007/s00701-016-2784-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/21/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aneurysmal rebleed is the most dreaded complication following subarachnoid hemorrhage. Being a cause of devastating outcome, the stratification of risk factors can be used to prioritize patients, especially at high volume centers. METHOD A total of 99 patients with aneurysmal rebleed were analyzed in this study both prospectively and retrospectively from August 2010 to July 2014. In the control group, 100 patients were selected randomly from the patient registry. A total of 25 variables from the demographic, historical, clinical and radiological data were compared and analyzed by univariate and multivariate logistic regression analysis. RESULTS Significant independent predictors of aneurysm rebleed were the presence of known hypertension (p = 0.023), diastolic blood pressure of >90 mmHg on admission (p = 0.008); presence of loss of consciousness (p = 0.013) or seizures (p = 0.002) at first ictus; history of warning headaches (p = 0.005); higher Fisher grade (p < 0.001); presence of multiple aneurysms (p = 0.021); irregular aneurysm surface (0.002). CONCLUSIONS Identification of high risk factors can help in stratifying patients in the high risk group. The risk stratification strategy with early intervention can prevent rebleeds. This in turn may translate into better outcomes of patients with intracranial aneurysms.
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Affiliation(s)
- Chirag Solanki
- Department of Neurosurgery, NIMHANS (National Institute of Mental Health and Neuroscinences), Bengaluru, Karnataka, 560029, India
| | - Paritosh Pandey
- Consultant Neurosurgeon, Manipal Hospital, Bengaluru, Karnataka, India
| | - K V L N Rao
- Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, 560029, India.
- Department of Neurosurgery, Faculty Block, Neurosurgery office, NIMHANS campus, Bengaluru, Karnataka, 560029, India.
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Lee SH, Song KJ, Shin SD, Ro YS, Kim MJ, Holmes JF. The Relationship between Clinical Outcome in Subarachnoidal Hemorrhage Patients with Emergency Medical Service Usage and Interhospital Transfer. J Korean Med Sci 2015; 30:1889-95. [PMID: 26713067 PMCID: PMC4689836 DOI: 10.3346/jkms.2015.30.12.1889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/29/2015] [Indexed: 12/05/2022] Open
Abstract
Prompt diagnosis and appropriate transport of patients with subarachnoid hemorrhage (SAH) is critical. We aimed to study differences in clinical outcomes by emergency medical services (EMS) usage and interhospital transfer in patients with SAH. We analyzed the CAVAS (CArdioVAscular disease Surveillance) database which is an emergency department-based, national cohort of cardiovascular disease in Korea. Eligible patients were adults with non-traumatic SAH diagnosed between January 2007 and December 2012. We excluded those whose EMS use and intershopital transfer data was unknown. The primary and secondary outcomes were mortality and neurologic status at discharge respectively. We compared the outcomes between each group using multivariable logistic regressions, adjusting for sex, age, underlying disease, visit time and social history. Of 5,461 patients with SAH, a total of 2,645 were enrolled. Among those, 258 used EMS and were transferred from another hospital, 686 used EMS only, 1,244 were transferred only, and 457 did not use EMS nor were transferred. In the regression analysis, mortality was higher in patients who used EMS and were transferred (OR 1.40, 95% CI 1.02-1.92), but neurologic disability was not meaningfully different by EMS usage and interhospital transfer. In Korea, SAH patients' mortality is higher in the case of EMS use or receiving interhospital transfer.
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Affiliation(s)
- Sang Hwa Lee
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Min Jung Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - James F. Holmes
- Department of Emergency Medicine, UC Davis Medical Center(JFH), Davis, CA, USA
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Alfotih GTA, Li F, Xu X, Zhang S. Risk factors for re-bleeding of aneurysmal subarachnoid hemorrhage: Meta-analysis of observational studies. Neurol Neurochir Pol 2014; 48:346-55. [DOI: 10.1016/j.pjnns.2014.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/30/2014] [Accepted: 08/15/2014] [Indexed: 11/30/2022]
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Tang C, Zhang TS, Zhou LF. Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis. PLoS One 2014; 9:e99536. [PMID: 24911172 PMCID: PMC4049799 DOI: 10.1371/journal.pone.0099536] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/15/2014] [Indexed: 11/19/2022] Open
Abstract
Background Rebleeding is a serious complication of aneurysmal subarachnoid hemorrhaging. To date, there are conflicting data regarding the factors contributing to rebleeding and their significance. Methods A systematic review of PubMed and Embase databases was conducted for studies pertaining to aneurysmal subarachnoid hemorrhage (aSAH) and rebleeding in order to assess the associated risk factors. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated from fourteen studies comprised of a total of 5693 patients that met the inclusion criteria. Results Higher rebleeding rates were observed < 6 h after the initial aSAH (OR = 3.22, 95% CI = 1.46–7.12), and were associated with high systolic blood pressure (OR = 1.93, 95% CI = 1.31–2.83), poor Hunt-Hess grade (III–IV) (OR = 3.43, 95% CI = 2.33–5.05), intracerebral or intraventricular hematomas (OR = 1.65, 95% CI = 1.33–2.05), posterior circulation aneurysms (OR = 2.15, 95% CI = 1.32–3.49), and aneurysms >10 mm in size (OR = 1.70, 95% CI = 1.35–2.14). Conclusions Aneurysmal rebleeding occurs more frequently within the first 6 hours after the initial aSAH. Risk factors associated with rebleeding include high systolic pressure, the presence of an intracerebral or intraventricular hematoma, poor Hunt-Hess grade (III-IV), aneurysms in the posterior circulation, and an aneurysm >10 mm in size.
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Affiliation(s)
- Chao Tang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Tian-Song Zhang
- Department of TCM, Shanghai Jing-an District Central hospital, Shanghai, China
| | - Liang-Fu Zhou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- * E-mail:
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Risk Factors Related to Aneurysmal Rebleeding. World Neurosurg 2011; 76:292-8; discussion 253-4. [DOI: 10.1016/j.wneu.2011.03.025] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 12/28/2010] [Accepted: 03/22/2011] [Indexed: 11/17/2022]
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Cha KC, Kim JH, Kang HI, Moon BG, Lee SJ, Kim JS. Aneurysmal rebleeding : factors associated with clinical outcome in the rebleeding patients. J Korean Neurosurg Soc 2010; 47:119-23. [PMID: 20224710 DOI: 10.3340/jkns.2010.47.2.119] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 12/21/2009] [Accepted: 01/03/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Aneurysmal rebleeding is a major cause of death and disability. The aim of this study is to investigate the incidence of rebleeding, and the factors related with patient's outcome. METHODS During a period of 12 years, from September 1995 to August 2007, 492 consecutive patients with aneurysmal subarachnoid hemorrhage (SAH) underwent surgery at our institution. We reviewed the patient's clinical records, radiologic findings, and possible factors inducing rebleeding. Also, we statistically analyzed various factors between favorable outcome group (FG) and unfavorable outcome group (UG) in the rebleeding patients. RESULTS Rebleeding occurred in 38 (7.7%) of 492 patients. Male gender, location of aneurysm (anterior communicating artery) were statistically significant between rebleeding group and non-rebleeding group (p = 0.01 and p = 0.04, respectively). Rebleeding occurred in 26 patients (74.3%) within 2 hours from initial attack. There were no statistically significant factors between FG and UG. However, time interval between initial SAH to rebleeding was shorter in the UG compared to FG (FG = 28.71 hrs, UG = 2.9 hrs). CONCLUSION Rebleeding occurs more frequently in the earlier period after initial SAH. Thus, careful management in the earlier period after SAH and early obliteration of aneurysm will be necessary.
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Affiliation(s)
- Ki Chul Cha
- Department of Neurosurgery, Eulji University School of Medicine Eulji General Hospital, Seoul, Korea
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Miyazaki T, Ohta F, Moritake K, Nagase A, Kagawa T. The key to improving prognosis for aneurysmal subarachnoid hemorrhage remains in the pre-hospitalization period. ACTA ACUST UNITED AC 2006; 65:360-5, discussion 365-6. [PMID: 16531194 DOI: 10.1016/j.surneu.2005.10.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Accepted: 10/10/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite advances in neurosurgical management, aneurismal subarachnoid hemorrhage (aSAH) still has high mortality and morbidity. This study aimed to clarify how delaying hospital admission after aSAH contributes to worse prognosis even today and to find the possibility for an improvement of its prognosis by early admission. METHODS Four hundred twenty-one consecutive patients are the basis for this study. Cause of delay was classified into 5 categories: patient delay (PD), doctor delay (DD), transportation delay (TD), no delay (ND) (within 2 hours of onset), and others. Condition of each patient was assessed at time of onset and admission using H&K. The relationships between cause of delay and worsening of Hunt and Kosnik grading (H&K) were examined. RESULTS The median delay time was 1.7 days. Only 41% of patients visited our institution without delay. Admission delay, especially PD and DD, exhibited a significant correlation to worsening of H&K. In addition to nondirect admission, misdiagnosis or delayed diagnosis contributed significantly to worsening of H&K. Incidence of DD has declined in recent years, whereas that of PD has increased. Consequently, no change in total number of delays was found. CONCLUSIONS There remains much room for an improvement of prognosis for aSAH by early admission. We need to fully realize this reality and to directly face this problem.
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Affiliation(s)
- Takeshi Miyazaki
- Department of Neurosurgery, Masuda Red Cross Hospital, Masuda 698-8501, Japan.
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