Objective: To determine the outcome of patients with subarachnoid haem
orrhage and whether delays in their diagnosis and referral have been r
educed over a 15-year period. Design: A 15-year retrospective study of
patients admitted to a tertiary neurosurgical unit between 1977 and 1
992. Setting: The Royal North Shore Hospital, Sydney, Patients: 511 pa
tients admitted with subarachnoid haemorrhage from ruptured intracrani
al aneurysms. Results: Of 486 patients with at least a six-month follo
w-up, 66% made a good recovery and 19% died. Outcome was significantly
influenced by the neurological condition of the patient at admission
(P<0.0001). There was no significant difference in the relative propor
tions of patients transferred late (three or more days after onset of
symptoms) when those admitted before and after 1986 were compared. Con
clusion: Delayed diagnosis and referral remain the major preventable p
roblems in the management of patients with aneurysmal subarachnoid hae
morrhage.