SAH Outcomes Better
Bret Michaels’s favorable outcome with subarachnoid hemorrhage (SAH) is one thing. But are we better at treating SAH now than 25 years ago?
The happy answer, yes, is suggested by a newly published time-trend study in the journal Neurology.
By using data from 2 vascular-study populations (OSCP and OXVASC), British investigators examined the outcomes of patients who developed aneurysmal SAH in the respective time periods of 1981-1986 and 2002-2008. They found no temporal differences in the incidence or severity of SAH, but a significantly greater proportion of patients surviving to the hospital in the later cohort underwent imaging (67% vs 23%) and aneurysmal treatment (50% vs 19%). The median delay to any interventional treatment was also significantly shorter in the later cohort (2 vs 14 days). Among treated aneurysms, all 5 in the earlier cohort were secured by clips; in the latter cohort, 83% were treated with endovascular embolization.
Age- and sex-adjusted 30-day case fatality tended to be lower in the later cohort (43% vs 67%); but this difference was not statistically significant. Among those patients reaching the hospital alive, the 12-month risk of death or dependency* was reduced by a significant 51%.
The authors also performed a meta-analysis of selected MEDLINE articles and found that the case-fatality rate of SAH has dropped by about 1% per year, from 1980 to 2005.
In an accompanying editorial, neurosurgeon Cargill Alleyne, Jr.,** of the Medical College of Georgia, warns that the numbers of SAH cases in the time-trend study were small (27 and 38 in the respective cohorts); nevertheless, the findings are consistent with the observations of seasoned practitioners.
OSCP = Oxford Community Stroke Project; OXVASC = Oxford Vascular Study.
* Adjusted for age and SAH severity.
** Who performed his fellowship at the Barrow Neurological Institute, where Michaels was treated.
Image from Wikipedia: Horizontal CT cut showing hyperdense subarachnoid blood in the basal cistern.