Functional Outcome After Poor-Grade Subarachnoid Hemorrhage: A Single-Center Study and Systematic Literature Review

被引：69

作者：

de Oliveira Manoel, Airton Leonardo ^{[1
,2
,3
,4
]}

Mansur, Ann ^{[3
,8
]}

Silva, Gisele Sampaio ^{[4
,9
]}

Germans, Menno R. ^{[5
]}

Jaja, Blessing N. R. ^{[3
]}

Kouzmina, Ekaterina ^{[1
]}

Marotta, Thomas R. ^{[1
,3
]}

Abrahamson, Simon ^{[2
,6
]}

Schweizer, Tom A. ^{[3
]}

Spears, Julian ^{[3
,7
]}

Macdonald, R. Loch ^{[3
,7
]}

机构：

[1] Univ Toronto, St Michaels Hosp, Dept Med Imaging, Intervent Neuroradiol, 3-141 CC,30 Bond St, Toronto, ON M5B 1W8, Canada

[2] Univ Toronto, St Michaels Hosp, Trauma & Neurosurg Intens Care Unit, Dept Crit Care Med, Toronto, ON, Canada

[3] St Michaels Hosp, Keenan Res Ctr Biomed Sci, Neurosci Res Program, Toronto, ON, Canada

[4] Univ Fed Sao Paulo, Neurol & Neurosurg Dept, Sao Paulo, Brazil

[5] Radboud Univ Nijmegen, Med Ctr, Dept Neurosurg, Nijmegen, Netherlands

[6] Univ Toronto, St Michaels Hosp, Dept Anesthesiol, Toronto, ON, Canada

[7] Univ Toronto, St Michaels Hosp, Dept Surg, Div Neurosurg, Toronto, ON, Canada

[8] Univ Toronto, Fac Med, Toronto, ON, Canada

[9] Inst Israelita Pesquisa Albert Einstein, Neurol Program, Sao Paulo, Brazil

来源：

NEUROCRITICAL CARE | 2016年 / 25卷 / 03期

关键词：

Subarachnoid hemorrhage; Prognosis; Mortality; Systematic review; RUPTURED INTRACRANIAL ANEURYSMS; CRITICAL-CARE MANAGEMENT; ENDOVASCULAR COILING; CEREBRAL ANEURYSMS; CASE-FATALITY; FOLLOW-UP; MORTALITY; TRIAL; SURGERY; NIMODIPINE;

D O I：

10.1007/s12028-016-0305-3

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Poor-grade subarachnoid hemorrhage (SAH) (World Federation of Neurosurgical Societies grade 4 and 5) is associated with high mortality rates and unfavorable functional outcomes. We report a single-center cohort of poor-grade SAH patients, combined with a systematic review of studies reporting functional outcome in the poor-grade SAH population. Data on a cohort of poor-grade SAH patients treated between 2009 and 2013 were retrospectively collected and combined with a systematic review (from inception to November 2015; PubMed, Embase). Two reviewers assessed the studies independently based on predefined inclusion criteria: consecutive poor-grade SAH, functional outcome measured at least 3 months after hemorrhage, and the report of patients who died before aneurysm treatment. The search yielded 329 publications, and 23 met our inclusion criteria with 2713 subjects enrolled from 1977 to 2014 in 10 countries (including 179 poor-grade patients from our cohort). Mortality rate was 60 % (1683 patients), of which 806 (29 %) died before and 877 (31 %) died after aneurysm treatment, respectively. Treatment was undertaken in 1775 patients (1775/2826-63 %): 1347 by surgical clipping (1347/1775-76 %) and 428 (428/1775-24 %) by endovascular methods. Outcome was favorable in 794 patients (28 %) and unfavorable in 1867 (66 %). When the studies were grouped into decades, favorable outcome increased from 13 % in the late 1970s to early 1980s to 35 % in the late 1980s to early 1990s, and remained unchanged thereafter. Although mortality remains high in poor-grade SAH patients, a favorable functional outcome can be achieved in approximately one-third of patients. The development of new diagnostic methods and implementation of therapeutic approaches were probably responsible for the decrease in mortality and improvement in the functional outcome from 1970 to the 1990s. The plateau in functional outcome seen thereafter might be explained by the treatment of sicker and older patients and by the lack of new therapeutic interventions specific for SAH.

引用

页码：338 / 350

页数：13

共 68 条

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