Loss of Consciousness at Onset of Subarachnoid Hemorrhage as Marker of Short Term Outcome

Journal of National Institute of Neurosciences Bangladesh Pub Date : 2021-01-01 DOI:10.3329/jninb.v7i1.54746

Rahat Amin Chowdhury, H. Rahman, A. Hasan, Iftikher Alam, M. Habib

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Abstract

Background: Studies assessing the impact of loss of consciousness (LOC) on prognosis of subarachnoid hemorrhage (SAH) has been limited. Objective: This scientific assessment was done to determine the effect of LOC on outcome of SAH. Methodology: This hospital based observational study was done in Department of Neurology of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2018 to December 2018. Patients with the diagnosis of SAH admitted in the in-patient wards of Neurology, Neurosurgery and Internal Medicine were taken as study population. The patients were divided in two groups with either presence (B) or absence of loss of consciousness (A). Group B was further subdivided into 3 subgroup depending admission WFNS scale grades (BI= WFNS II &III, BII=WFNS IV and BIII=WFNS V). Follow up was done in the stroke clinic, outpatient department of Neurology or by telephone interviews of patients, caregivers or family members. Outcome was measured by modified Rankin Scale (mRS). Result: A total of 75 patients were divided into group A and Group B. Six (8.0%) patients died during hospital stay, 6 died after 3 months. All those died during hospital stay were from group B. At 3 months, 16(21.3%) patients were lost during follow up. In group A at discharge 28.6% patients had poor outcome whereas 36% of patients in group B had poor outcome. Within group B most of the patients having poor outcome were in subgroup BIII (75.0%) compared to 33.0% cases in BI (p=0.023). About 16.7% cases in group A had poor outcome at 3 months and 75.0% cases in Group BIII. Furthermore, 8.3% patients died in Group A, however, 25.0% died in Group BIII. WFNS grade (IV or V) had statistically significant influence on poor outcome among patients having LOC (adjusted Odds ratio is 2.20, p=0.04 and 95% CI 1.03–4.71). Conclusion: Loss of consciousness at onset of SAH is an important marker for p oor outcome. Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 20-24

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蛛网膜下腔出血发作时意识丧失作为短期预后的标志

背景:评估意识丧失(LOC)对蛛网膜下腔出血(SAH)预后影响的研究有限。目的:科学评价LOC对SAH转归的影响。方法:本观察性研究于2018年1月至2018年12月在孟加拉国达卡达卡医学院医院神经内科完成。以神经内科、神经外科和内科住院病房确诊为SAH的患者为研究对象。将患者分为有意识丧失(B)和无意识丧失(A)两组，B组根据入院WFNS评分等级(BI= WFNS II和iii级，BII=WFNS IV级，BIII=WFNS V级)进一步分为3个亚组，随访在卒中门诊、神经内科门诊或通过电话采访患者、护理人员或家属。采用改良Rankin量表(mRS)评价预后。结果:75例患者分为A组和b组，住院期间死亡6例(8.0%)，3个月后死亡6例。住院期间死亡患者均为b组，随访3个月时丢失16例(21.3%)。出院时，A组28.6%的患者预后不良，而B组36%的患者预后不良。在B组中，大多数预后不良的患者为BIII亚组(75.0%)，而BI亚组为33.0% (p=0.023)。A组约16.7%的患者3个月预后不良，BIII组约75.0%。A组死亡率为8.3%，而BIII组死亡率为25.0%。WFNS分级(IV或V级)对LOC患者预后不良有统计学意义(校正优势比为2.20,p=0.04, 95% CI 1.03-4.71)。结论:SAH发病时意识丧失是预后不良的重要标志。孟加拉国国家神经科学研究所杂志，2021年1月，第7卷，第1期，第20-24页

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Journal of National Institute of Neurosciences Bangladesh

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