DELAYED REFERRAL OF PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE

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.