PROGRESS IN THE MANAGEMENT OF PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRAHAGE - A SINGLE HOSPITAL REVIEW FOR 20 YEARS .1. YOUNGER PATIENTS

BACKGROUND This study was carried out to clarify if there has been any improvement in the outcome of patients with aneurysmal subarachnoid h emorrhage during the past 20 years. Because elderly patients have appa rently poorer prognoses than younger patients, patients older than 70 years were analyzed separately in the following article. METHODS Five hundred seventy-one patients with aneurysmal subarachnoid hemorrhage, under 70 years, who were consecutively admitted to Kagawa Prefectural Central Hospital from July 1972 to December 1992, were reviewed. These patients were divided into four groups according to the time of admis sion. The ultimate outcome was evaluated by means of Glasgow Outcome S cale 6 months after the ictus. RESULTS Changes in treatment protocol i n this period included the induction of early surgery and the inventio n of a variety of modalities for the treatment of cerebral vasospasm. This resulted in a distinct increase in patients who actually underwen t direct aneurysm clipping. Outcome has been significantly improved du ring this period, especially in patients with Hunt and Kosnik grade II I (P < 0.05, chi(2)). Patients in good clinical condition at follow-up (Glasgow Outcome Scale: good recovery) increased from 8.7% to 60.7%. Mortality decreased from 28.7% to 10.7%. CONCLUSIONS Current therapeut ic modalities have significantly improved the outcome of patients with aneurysmal subarachnoid hemorrhage. Rebleeding before early surgery r emains as a major cause of unfavorable outcome and further progress on this subject is mandatory.