Universität zu Köln

Goertz, Lukas, Pflaeging, Muriel, Hamisch, Christina, Kabbasch, Christoph, Pennig, Lenhard, von Spreckelsen, Niklas ORCID: 0000-0002-9873-1711, Laukamp, Kai, Timmer, Marco, Goldbrunner, Roland, Brinker, Gerrit and Krischek, Boris (2021). Delayed hospital admission of patients with aneurysmal subarachnoid hemorrhage: clinical presentation, treatment strategies, and outcome. J. Neurosurg., 134 (4). S. 1182 - 1190. ROLLING MEADOWS: AMER ASSOC NEUROLOGICAL SURGEONS. ISSN 1933-0693

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Abstract

OBJECTIVE Timely aneurysm occlusion and neurointensive care treatment are key principles in the management of aneurysmal subarachnoid hemorrhage (aSAH) to prevent secondary brain injury. Patients with early (EHA) and delayed hospital admission (DHA) were compared in terms of clinical presentation, treatment strategies, aSAH-related complications, and outcome. METHODS In this retrospective study, consecutive aSAH patients were treated at a single neurovascular center between 2009 and 2019. Propensity score matching was performed to account for divergent baseline characteristics. RESULTS Among 509 included patients, 55 were admitted more than 48 hours after ictus (DHA group). DHA patients were significantly younger (52 +/- 11 vs 56 +/- 14 years, p = 0.03) and had lower World Federation of Neurosurgical Societ- ies scores (p < 0.01) than EHA patients. In 54.5% of the cases, DHA patients presented with neurological deterioration or aggravated symptoms. Propensity score matching revealed a higher vasospastic infarction rate in the DHA group (41.5%) than in the EHA group (22.6%) (p = 0.04). A similar portion of patients in both groups achieved favorable out- come at midterm follow-up (77.3% vs 73.6%, p = 0.87). DHA patients (62.3%) received conventional coiling more often than EHA patients (41.5%) (p = 0.03). CONCLUSIONS DHA patients are at an increased risk of cerebral infarction. Nevertheless, state-of-the-art neurointensive care treatment can result in a good clinical outcome.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Goertz, Lukas UNSPECIFIED UNSPECIFIED UNSPECIFIED Pflaeging, Muriel UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamisch, Christina UNSPECIFIED UNSPECIFIED UNSPECIFIED Kabbasch, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Pennig, Lenhard UNSPECIFIED UNSPECIFIED UNSPECIFIED von Spreckelsen, Niklas UNSPECIFIED orcid.org/0000-0002-9873-1711 UNSPECIFIED Laukamp, Kai UNSPECIFIED UNSPECIFIED UNSPECIFIED Timmer, Marco UNSPECIFIED UNSPECIFIED UNSPECIFIED Goldbrunner, Roland UNSPECIFIED UNSPECIFIED UNSPECIFIED Brinker, Gerrit UNSPECIFIED UNSPECIFIED UNSPECIFIED Krischek, Boris UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-593778
DOI:	10.3171/2020.2.JNS20148
Journal or Publication Title:	J. Neurosurg.
Volume:	134
Number:	4
Page Range:	S. 1182 - 1190
Date:	2021
Publisher:	AMER ASSOC NEUROLOGICAL SURGEONS
Place of Publication:	ROLLING MEADOWS
ISSN:	1933-0693
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language VEHICLE-CONTROLLED TRIAL; TIRILAZAD MESYLATE; CEREBRAL-ISCHEMIA; DOUBLE-BLIND; DIAGNOSIS; VASOSPASM; MISDIAGNOSIS Multiple languages Clinical Neurology; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59377