Key result
A shorter interval between symptom onset and hospital admission was independently associated with a higher risk of poorer clinical outcomes (OR 1.845) in patients with aneurysmal subarachnoid hemorrhage.
Why the study?
Early treatment for aneurysmal subarachnoid hemorrhage reduces re-bleeding risk and improves outcomes, but the time intervals and risk factors contributing to treatment delay needed assessment.
Observational (n=422)
No
Odds Ratio: 1.845 (95% CI 1.018–3.344)
In a high-volume center, endovascular treatment for aSAH was performed on the same day of admission in over 90% of patients, with pre-hospital delay being the main cause of treatment delay, and shorter onset-to-admission interval paradoxically predicting poorer outcomes, likely due to more severe initial presentations.
Delays in aSAH endovascular care may signal systemic barriers; hypothesis-generating for prospective studies on modifiable risk factors.
BACKGROUND: Early treatment for patients with aneurysmal subarachnoid hemorrhage (aSAH) could significantly reduce the risk of re-bleeding and improve clinical outcomes. We assessed the different time intervals from the initial hemorrhage, admission, and endovascular treatment and identified the risk factors contributing to delay. METHODS: Between February 2017 and December 2019, 422 consecutive aSAH patients treated in a high-volume hospital were collected and reviewed. Risk factors contributing to admission delay and treatment delay were analyzed with univariate and multivariate analysis. RESULTS: One hundred twenty-two (28.9%) were admitted to the high-volume hospital at the day of symptom onset and 386 (91.5%) were treated with endovascular management at the same day of admission. The multivariate analysis found that younger age (P = 0.022, OR = 0.981, 95% CI 0.964-0.997) and good Fisher score (P = 0.002, OR = 0.420, 95% CI 0.245-0.721) were independent risk factors of admission delay. None was found to be related with treatment delay. Multivariate analysis (OR (95% CI)) showed that higher age 1.027 (1.004-1.050), poorer Fisher score 3.496 (1.993-6.135), larger aneurysmal size 1.112 (1.017-1.216), and shorter interval between onset to admission 1.845 (1.018-3.344) were independent risk factors of poorer clinical outcome. CONCLUSION: Treatment delay was mainly caused by pre-hospital delay including delayed admission and delayed transfer. Our experience showed that cerebrovascular team could provide early treatment for aSAH patients. Younger age and good Fisher score were significantly related with admission delay. However, admission delay was further significantly correlated with better clinical outcome.
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Zhang et al. (2021) conducted an observational in aneurysmal subarachnoid hemorrhage (n=422). Shorter interval between onset to admission vs. Longer interval (admission delay) was evaluated on Poorer clinical outcome (mRS 3-6 at discharge) (OR 1.845, 95% CI 1.018-3.344). A shorter interval between symptom onset and hospital admission was independently associated with a higher risk of poorer clinical outcomes (OR 1.845) in patients with aneurysmal subarachnoid hemorrhage.
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