PREDICTING OUTCOME IN POOR-GRADE PATIENTS WITH SUBARACHNOID HEMORRHAGE - A RETROSPECTIVE REVIEW OF 159 AGGRESSIVELY MANAGED CASES

To determine what factors predict outcome, the authors retrospectively reviewed the management of all 159 poor-grade patients admitted to Ha rborview Medical Center at the University of Washington who suffered a neurysmal subarachnoid hemorrhage between 1983 and 1993. Favorable out come (assessed by the Glasgow Outcome Scale) occurred in 53.9% of Hunt and Hess Grade IV, and 24.1% of Grade V patients. Outcome was largely determined by the initial hemorrhage and subsequent development of in tractable intracranial hypertension or cerebral infarction. Using mult ivariate analysis, the authors developed three models to predict outco me. It was found that predicting outcome based only on clinical and di agnostic criteria present at admission may have resulted in withholdin g treatment from 30% of the patients who subsequently experienced favo rable outcomes. It is concluded that aggressive management including s urgical aneurysm obliteration can benefit patients with poor neurologi cal grades and should not be denied solely on the basis of the neurolo gical condition on admission.