INITIAL AND RECURRENT BLEEDING ARE THE MAJOR CAUSES OF DEATH FOLLOWING SUBARACHNOID HEMORRHAGE

Background and Purpose The goal of this study was to determine the cau ses of mortality and morbidity after subarachnoid hemorrhage. Methods We identified all first-ever spontaneous subarachnoid hemorrhages that occurred in the nearly 1.3 million population of greater Cincinnati d uring 1988. Results Thirty-day mortality for subarachnoid hemorrhage w as 45% (36 of 80 cases). Of the 36 deaths, 22 (61%) died within 2 days of onset; 21 of these deaths were due to the initial hemorrhage, and one death was due to rebleeding documented by computed tomography. Nin e of the remaining 14 deaths after day 2 were caused by the initial he morrhage (2 cases) or rebleeding (7 cases). Volume of subarachnoid hem orrhage was a powerful predictor of 30-day mortality (P=.0001). Only 3 of the 29 patients with a volume of subarachnoid hemorrhage of 15 cm( 3) or less died before 30 days. Two of these 3 patients died from docu mented rebleeding; the third had 87 cm(3) of additional intraventricul ar hemorrhage. Delayed arterial vasospasm contributed to only 2 of all 36 deaths. Conclusions Most deaths after subarachnoid hemorrhage occu r very rapidly and are due to the initial hemorrhage. Rebleeding is th e most important preventable cause of death in hospitalized patients. In a large representative metropolitan population, delayed arterial va sospasm plays a very minor role in mortality caused by subarachnoid he morrhage.