Prompt treatment urged for bleeding intracranial aneurysms

By Eleanor McDermid, Senior medwireNews Reporter

Patients with subarachnoid hemorrhage (SAH) have an increased chance of being discharged with minimal or no disability if the culprit aneurysm is promptly treated, suggests US research.

The analysis of 32,048 patients in the US Nationwide Inpatient Sample for the years 2005 through 2008 indicates that treatment is often delayed if patients are admitted at the weekend. Treatment was delayed (by more than 48 hours) in 31.6% of patients admitted at the weekend, compared with in just 25.4% of those admitted during the week - a significant difference.

"We therefore suggest that strong consideration should be made to transfer SAH patients presenting on the weekend to the nearest teaching hospitals with endovascular capabilities, particularly if delay in treatment is anticipated," say Farhan Siddiq (University of Minnesota, Minneapolis) and colleagues.

Also, patients were more likely to receive early treatment if they received endovascular rather than surgical intervention, or if they were female.

At discharge, more patients given early versus delayed treatment had minimal or no disability (51.1 vs 47.1%) and fewer had moderate or severe disability (34.7 vs 41.8%). After accounting for confounders, this equated to a 30% increase in the likelihood for minimal or no disability and a 23% reduction in the risk for moderate or severe disability.

However, more patients in the early-treatment group died, at 13.9%, compared with 10.9% in the delayed-treatment group, equating to a 36% increase in mortality risk after accounting for confounders including comorbidities and a risk algorithm gauging patients' baseline mortality risk.

"With the widespread availability of endovascular coil embolization, we believe that poor clinical grade SAH patients are being treated more frequently and earlier in current practice," write Siddiq et al in Anesthesiology.

"In the early treatment group, patients were more likely to be discharged with minimal disability, which suggests that the major benefit of early treatment is reduction of disability, but is unlikely to improve survival in patients with poor clinical grade and extensive comorbidities."

The average length of hospital stay was significantly lower in the early- versus the delayed-treatment group, at 17.3 versus 19.7 days, and treatment costs were around 10% lower.

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