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Subarachnoid haemorrhage WFNS grade V: is maximal treatment worthwhile?
MedLine Citation:
PMID:  23397308     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Aneurysmal subarachnoid haemorrhage (SAH) WFNS grade V is commonly known to be associated with high mortality and a very poor prognosis for survivors. Therefore, maximal invasive therapy is frequently delayed until any spontaneous improvement with or without an external ventricular drainage occurs. The aim of the study was to verify possible predictive factors and the probability of a favourable outcome in maximally treated patients. METHODS: One hundred and thirty-eight consecutive patients with WFNS grade V SAH were admitted between 03/2006 and 12/2010. Thirty-five patients died before aggressive therapy could proceed. One hundred and three patients received maximal treatment and were retrospectively evaluated. The outcome was assessed at discharge and in the follow-up with the Glasgow Outcome Scale. Univariate and multivariate linear regression models were performed to find predictors for an unfavourable outcome. RESULTS: Despite treatment, early mortality was 30 % (n = 31). At discharge, the rate of both vegetative and severely disabled patients was 27 % (n = 28). Favourable outcome at discharge was observed in 16 % (n = 16) of cases, whereas in the follow-up it rose to 26 % (n = 27). Multivariate full model regression identified intraventricular haematoma (IVH) and increasing age as independently predictive for poor outcome. CONCLUSIONS: Despite treatment, initial mortality and severe disability remain high. Nevertheless, a favourable outcome was achieved in 26 % of aggressively treated patients, rendering the withdrawal of maximal therapy for WFNS grade V SAH patients unacceptable today. In cases of old patients with IVH, the indication for aggressive therapy should be put in place more carefully due to a very poor prognosis.
Authors:
Maria Wostrack; Nora Sandow; Peter Vajkoczy; Bawarjan Schatlo; Philippe Bijlenga; Karl Schaller; Victoria Kehl; Kathrin Harmening; Florian Ringel; Yu-Mi Ryang; Benjamin Friedrich; Michael Stoffel; Bernhard Meyer
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-12
Journal Detail:
Title:  Acta neurochirurgica     Volume:  -     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany, maria.wostrack@lrz.tum.de.
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