Predicting Outcome of Poor Grade Patients of Subarachnoid Haemorrhage Due to Anterior Communicating Artery Aneurysm
Journal Title: Journal of Neurological Sciences-Turkish - Year 2007, Vol 24, Issue 4
Abstract
Background: This study deals with analyzing our protocol in managing patients of poor grade aneurysmal subarachnoid haemorrhage (aSAH) and in determining the factors that influenced outcome. The aim of our study is to find the outcome following aneurysmal subarachnoid haemorrhage in poor grade patients due to anterior communicating artery aneurysm and to find out if outcome could be predicted on basis of presentation. Material and Methods: This is a retrospective study of 71 patients of aSAH due to anterior communicating artery aneurysm who were in Hunt and Hess grade IV and V. The efficacy of aggressive management on outcome and the potential factors influencing outcome were analyzed. The outcome was assessed on basis of Glasgow outcome scale (GOS) as favorable (GOS 3 to 5) or unfavorable group (GOS of 2 or 1) Statistical method: Initially all the factors that were presumed to affect the outcome were analyzed for statistical significance using cross-tab and chi-square analysis. At 95%, confidence interval p values were calculated and p≤ 0.05 was considered significant. Than a discriminant, analysis was done to assess the efficacy of various factors in predicting outcome. Results: We could predict the outcome correctly as poor in 62.7% of patients and good in 75% of patients. The overall predictability of outcome could be done correctly in 66.2% cases. In grade IV patients, we found favorable outcome in 20 patients (40 %) while in grade V it was not observed in any of the patient. Five factors were statistically significant (p<0.05) in predicting outcome, these were - Glasgow coma score, angiographic vasospasm, age, intraventricular haemorrhage and hydrocephalus. Conclusion: In patients with grade IV SAH outcome seems to be favorable with aggressive management and early surgery seems justified and is recommended. Early surgery did not lead to increased mortality. In grade V patients outcome is poor and it is not clear whether early or late surgery is best for these patients .The significant factors determining outcome are age, GCS and H&H grade, vasospasm, IVH and hydrocephalus. By initial presentation, one cannot predict outcome with reasonable accuracy so aggressive management is advocated in all patients of grade IV SAH and one cannot withhold treatment on basis of initial presentation alone. In cases of grade, V SAH we could not find good outcome in any patient, hence the aggressiveness of treatment in these patients is debatable.
Authors and Affiliations
Abrar WANI, Sanjay BEHARI, Vivek WAID, Awdesh JAISWAL, VK JAIN
Keywords
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