Key result
Delayed hospital arrival (>72 hours) in patients with aneurysmal subarachnoid hemorrhage was associated with a less severe clinical grade and no significant difference in post-admission rebleeding rates compared to early arrival.
Why the study?
The timing of aneurysmal obliteration may be influenced by post-admission rebleeding rates and patient characteristics associated with delayed hospital arrival in aneurysmal subarachnoid hemorrhage.
Does delayed hospital arrival affect post-admission rebleeding rates and clinical characteristics in patients with aneurysmal subarachnoid hemorrhage?
Cohort (n=5,101)
Yes
Does delayed hospital arrival affect post-admission rebleeding rates and clinical characteristics in patients with aneurysmal subarachnoid hemorrhage?
Absolute Event Rate: 0% vs 6.8%
p-value: p=0.17
Patients with aneurysmal subarachnoid hemorrhage arriving at the hospital more than 72 hours after onset have a similar post-admission rebleeding risk compared to early arrivals, but present with less severe hemorrhage grades despite a higher prevalence of pre-admission repeated ictus.
Delayed SAH arrivals may shape obliteration timing; hypothesis-generating for rebleeding-focused protocols pending prospective data.
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.
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Yamaguchi et al. (2025) conducted a cohort in Aneurysmal subarachnoid hemorrhage (n=5,101). Delayed hospital arrival (>72 hours post-onset) vs. Early hospital arrival (≤72 hours post-onset) was evaluated on Rebleeding after admission (p=0.17). Delayed hospital arrival (>72 hours) in patients with aneurysmal subarachnoid hemorrhage was associated with a less severe clinical grade and no significant difference in post-admission rebleeding rates compared to early arrival.
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