Changes in intervention and outcome in elderly patients with subarachnoid hemorrhage

被引:53
作者
Johansson, M
Cesarini, KG
Contant, CF
Persson, L
Enblad, P [1 ]
机构
[1] Univ Uppsala Hosp, Dept Neurosci, Neurosurg Sect, S-75185 Uppsala, Sweden
[2] Baylor Coll Med, Dept Neurosurg, Houston, TX 77030 USA
关键词
aged; intracranial aneurysm; neuropsychological test; subarachnoid hemorrhage;
D O I
10.1161/hs1201.099416
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-The elderly constitute a significant and increasing proportion of the population. The aim of this investigation was to study time trends in clinical management and outcome in elderly patients with subarachnoid hemorrhage. Methods-Two hundred eighty-one patients greater than or equal to 65 years of age with aneurysmal subarachnoid hemorrhage who were accepted for treatment at the Uppsala University Hospital neurosurgery clinic during 1981 to 1998 were included. Hunt and Hess grades on admission, specific management components, and clinical outcomes were recorded. Three periods were compared: A, 1981 to 1986 (before neurointensive care); B, 1987 to 1992; and C, 1993 to 1998. Results-The volume of elderly patients (greater than or equal to 65 years of age) increased with time, especially patients :70 years of age. Furthermore the proportion of patients with more severe clinical conditions increased. A greater proportion of patients had a favorable outcome (A, 45%, B, 61%; C, 58%) despite older ages and more severe neurological and clinical conditions. In period C, Hunt and Hess I to II patients had a favorable outcome in 85% of cases compared with 64% in period A. This was achieved without any increase in the number of severely disabled patients. Conclusions-Elderly patients with subarachnoid hemorrhage can be treated successfully, and results are still improving. The introduction of neurointensive care may have contributed to the improved outcome without increasing the proportion of severely disabled patients. A defeatist attitude toward elderly patients with this otherwise devastating disease is not justified.
引用
收藏
页码:2845 / 2849
页数:5
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