Influence of timing of admission after aneurysmal subarachnoid hemorrhage on overall outcome. Report of the cooperative aneurysm study.

Abstract

The overall management results after aneurysmal rupture were studied in 158 patients admitted to the hospital on day 0--3 and 175 patients admitted on day 4--7 following subarachnoid hemorrhage. In this series surgery was planned no sooner than 12 days following the ictus. Despite effective medical and surgical therapy overall results were disappointing: 3 months following the initial hemorrhage only 43% of patients in the 0--3 day group and 53% of patients in the 4--7 day group were capable of independent functional living. Patients admitted on days 4--7 also had a lower mortality rate, re-bled less frequently, and had lower postoperative mortality and morbidity than those admitted on days 0--3. For reasons not well defined, time of admission following aneurysmal SAH has an important influence on outcome. Accordingly, in evaluating outcome for patients with ruptured aneurysms treated with different therapeutic modalities, time of admission must be carefully controlled.