Outcomes and costs in the management of poor grade subarachnoid haemorrhage.

Poor-grade subarachnoid haemorrhage is associated with high morbidity and mortality, with good neurological outcomes in only 20-40% of patients. We retrospectively analysed the management, outcomes, and associated healthcare costs for patients presenting in poor neurological grade (WFNS grades 4-5) at a tertiary neurosurgical centre in Ireland between 2018 and 2022. Patients improving to WFNS grade 3 or better after initial resuscitation and/or CSF drainage were excluded. Seventy-two patients met the inclusion criteria, with a median age of 61.5 years. 75% were female. 59% of patients underwent aneurysm treatment, most using endovascular techniques. The median hospital length of stay was 25.72 days. The mean treatment cost was €39.895.15 per patient. 33.3% of patients achieved a favourable neurological outcome at 6 months (GOS 4 or 5). Our findings demonstrate the substantial cost burden and poor outcomes associated with poor-grade SAH, underscoring the need for better prognostic tools and optimised resource allocation.