Thomas J Wilson1, Yamaan Saadeh2, William R Stetler2, Aditya S Pandey2, Joseph J Gemmete3, Neeraj Chaudhary3, B Gregory Thompson2, Jeffrey J Fletcher4. 1. Department of Neurosurgery University of Michigan, Ann Arbor, Michigan. Electronic address: thowil@med.umich.edu. 2. Department of Neurosurgery University of Michigan, Ann Arbor, Michigan. 3. Bronson Methodist Hospital, Kalamazoo, Michigan. 4. Department of Neurosurgery University of Michigan, Ann Arbor, Michigan; Bronson Methodist Hospital, Kalamazoo, Michigan.
Abstract
OBJECTIVES: The objective of our study was to examine patients with aneurysmal subarachnoid hemorrhage transferred and directly admitted to our institution in order to determine how transfer time affects outcomes. METHODS: A retrospective cohort study was performed of all patients undergoing treatment for aneurysmal subarachnoid hemorrhage between 2005 and 2012 at the University of Michigan. Variables, including transfer time, were tested for their independent association with the primary outcomes of symptomatic vasospasm and 12-month outcome as well as secondary outcomes of aneurysm rebleeding and 12-month mortality. RESULTS: During the study period, 263 (87.4%) patients were transferred to our institution and 38 (12.6%) were directly admitted for treatment of aneurysmal subarachnoid hemorrhage. Transfer time was not associated with the occurrence of symptomatic vasospasm, 12-month outcome, rebleeding, or 12-month mortality. Higher Hunt-Hess grade was associated with the occurrence of symptomatic vasospasm as well as with poorer 12-month outcome. CONCLUSIONS: Transfer time was not associated with the occurrence of symptomatic vasospasm, 12-month outcome, rebleeding, or 12-month mortality. We believe our data argue that protocols should emphasize early resuscitation and stabilization followed by safe transfer rather than a hyperacute transfer paradigm. However, transfer time should be minimized as much as possible so as not to delay time to definitive treatment.
OBJECTIVES: The objective of our study was to examine patients with aneurysmal subarachnoid hemorrhage transferred and directly admitted to our institution in order to determine how transfer time affects outcomes. METHODS: A retrospective cohort study was performed of all patients undergoing treatment for aneurysmal subarachnoid hemorrhage between 2005 and 2012 at the University of Michigan. Variables, including transfer time, were tested for their independent association with the primary outcomes of symptomatic vasospasm and 12-month outcome as well as secondary outcomes of aneurysm rebleeding and 12-month mortality. RESULTS: During the study period, 263 (87.4%) patients were transferred to our institution and 38 (12.6%) were directly admitted for treatment of aneurysmal subarachnoid hemorrhage. Transfer time was not associated with the occurrence of symptomatic vasospasm, 12-month outcome, rebleeding, or 12-month mortality. Higher Hunt-Hess grade was associated with the occurrence of symptomatic vasospasm as well as with poorer 12-month outcome. CONCLUSIONS: Transfer time was not associated with the occurrence of symptomatic vasospasm, 12-month outcome, rebleeding, or 12-month mortality. We believe our data argue that protocols should emphasize early resuscitation and stabilization followed by safe transfer rather than a hyperacute transfer paradigm. However, transfer time should be minimized as much as possible so as not to delay time to definitive treatment.
Authors: Joey D English; Dileep R Yavagal; Rishi Gupta; Vallabh Janardhan; Osama O Zaidat; Andrew R Xavier; Raul G Nogueira; Jawad F Kirmani; Tudor G Jovin Journal: Interv Neurol Date: 2016-02-19
Authors: Sang Hwa Lee; Kyoung Jun Song; Sang Do Shin; Young Sun Ro; Min Jung Kim; James F Holmes Journal: J Korean Med Sci Date: 2015-11-30 Impact factor: 2.153