Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management

Background and Purpose-Rebleeding is a major cause of death and disability in aneurysmal subarachnoid hemorrhage (SAH); however, there has been no rep ort focusing on rebleeding before hospitalization in neurosurgical or neuro logical institutions. The aim of this study was to clarify the incidence of prehospitalization rebleeding. its impact on the clinical course and progn osis in patients with aneurysmal SAH, and the possible factors inducing it. Methods-In 273 patients who were admitted to our institution within 24 hour s after the initial SAI-I bleeding and whose clinical course before admissi on could be fully evaluated, the patients' clinical conditions and CT findi ngs on admission, operability, prognosis, and possible factors inducing reb leeding were comparatively evaluated between the patients with and without an episode of prehospitalization rebleeding. Results-Of the 273 patients, 37 (13.6%) patients suffered from 39 episodes of rebleeding in the ambulance or at the referring hospital before admissio n to our hospital. The peak time of rebleeding was within 2 hours (77%), in which the incidence was statistically significant compared with that occur ring 2 to 8 hours after thr initial SAH bleeding (P <0.01). The group exper iencing rebleeding showed more severe Hunt and Hess grades on admission, hi gher rates of intracerebral hematoma, of intraventricular hematoma, and of subdural hematoma on CT scan on admission, less operability, and poorer pro gnoses with statistically significant differences compared with the group t hat did not experience rebleeding. Systolic arterial pressure > 160 mm Hg w as a possible risk factor of rebleeding (odds ratio 3.1, 95% CI 1.5 to 6.8) . Conclusions-Rebleeding during transfer and at the referring hospital is not rare. To improve overall outcome of aneurysmal SAH, the results obtained i n this study should be made available to general practitioners and the doct ors devoted to emergency medicine.