Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in The Netherlands

Objective-The aim of this study was to investigate prospectively in an unse lected series of patients with an aneurysmal subarachnoid haemorrhage what at present the complications are, what the outcome is, how many of these pa tients have "modern treatment"-that is, early obliteration of the aneurysm and treatment with calcium antagonists-what factors cause a delay in surgic al or endovascular treatment, and what the estimated effect on outcome will be of improved treatment. Methods-A prospective, observational cohort study of all patients with aneu rysmal subarachnoid haemorrhage in the hospitals of a specified region in T he Netherlands. The condition on admission, diagnostic procedures, and trea tments were recorded. If a patient had a clinical deterioration, the change in Glasgow coma score (GCS), the presence of focal neurological signs, the results of additional investigations, and the final diagnosed cause of the deterioration were recorded. Clinical outcome was assessed with the Glasgo w outcome scale (GOS) at 3 month follow up. In patients with poor outcome a t follow up, the cause was diagnosed. Results-Of the 110 patients, 47 (43%) had a poor outcome. Cerebral ischaemi a, 31 patients (28%), was the most often occurring complication. Major caus es of poor outcome were the effects of the initial haemorrhage and rebleedi ng in 34% and 30% of the patients with poor outcome respectively. Of all pa tients 102 (93%) were treated with calcium antagonists and 45 (41%) patient s had early treatment to obliterate the aneurysm. The major causes of delay of treatment were a poor condition on admission or deterioration shortly a fter admission, in 31% and 23% respectively. Conclusions-In two thirds of the patients with poor outcome the causes of p oor outcome are the effects of the initial bleeding the The come are the ef fects or the initial bleeding and rebleeding. Improved treatment of delayed or postoperative ischaemia will have only minor effects on the outcome of patients with subarachnoid haemorrhage.