Characteristics of Patients with Aneurysmal Subarachnoid Hemorrhage with Delayed Hospital Arrival.

Abstract

The timing of aneurysmal obliteration may be influenced by post-admission rebleeding rates and patient characteristics associated with delayed hospital arrival in cases of aneurysmal subarachnoid hemorrhage. This study compared the rebleeding rate and characteristics between delayed and early hospital arrivals in cases of aneurysmal subarachnoid hemorrhage. Data from patients with aneurysmal subarachnoid hemorrhage recorded in the Nagasaki SAH Registry (1989-2018) were retrospectively analyzed. Patients were categorized into early (admission ≤72-hr post-onset) and late (admission >72-hr post-onset) groups. To assess the rebleeding rate after admission, data from a hospital that delayed the treatment protocol (1989-2002) were analyzed by using the log-rank test before and after propensity-score matching. To compare the characteristics of the late and early groups, data from 11 hospitals in the registry (2001-2018) were analyzed using multivariable analysis. The rebleeding analysis included 446 patients. Rebleeding occurred in 28/410 (6.8%) and 0/36 (0.0%) patients in the early and late groups, respectively, with no significant differences in cumulative rebleeding rates between the groups (11.5%/month vs. 0.0%/month, respectively). Of the 5,101 patients with aneurysmal subarachnoid hemorrhage admitted from 2001 to 2018, 289 (5.7%) were categorized into the late group. Multivariable analysis identified lower World Federation of Neurosurgical Societies/Fisher grade, anterior circulation aneurysm, fewer small aneurysms, late aneurysmal obliteration treatment, and pre-admission repeated ictus as independent factors associated with the late group. Patients with aneurysmal subarachnoid hemorrhage with delayed hospital arrival are uniquely characterized by a less severe subarachnoid hemorrhage grade, regardless of repeated pre-admission ictus.