Changes in intervention and outcome in elderly patients with subarachnoid hemorrhage

Background and Purpose-The elderly constitute a significant and increasing proportion of the population. The aim of this investigation was to study ti me trends in clinical management and outcome in elderly patients with subar achnoid hemorrhage. Methods-Two hundred eighty-one patients greater than or equal to 65 years o f age with aneurysmal subarachnoid hemorrhage who were accepted for treatme nt at the Uppsala University Hospital neurosurgery clinic during 1981 to 19 98 were included. Hunt and Hess grades on admission, specific management co mponents, and clinical outcomes were recorded. Three periods were compared: A, 1981 to 1986 (before neurointensive care); B, 1987 to 1992; and C, 1993 to 1998. Results-The volume of elderly patients (greater than or equal to 65 years o f age) increased with time, especially patients :70 years of age. Furthermo re the proportion of patients with more severe clinical conditions increase d. A greater proportion of patients had a favorable outcome (A, 45%, B, 61% ; C, 58%) despite older ages and more severe neurological and clinical cond itions. In period C, Hunt and Hess I to II patients had a favorable outcome in 85% of cases compared with 64% in period A. This was achieved without a ny increase in the number of severely disabled patients. Conclusions-Elderly patients with subarachnoid hemorrhage can be treated su ccessfully, and results are still improving. The introduction of neurointen sive care may have contributed to the improved outcome without increasing t he proportion of severely disabled patients. A defeatist attitude toward el derly patients with this otherwise devastating disease is not justified.