Timing of admission and management outcome in patients with subarachnoid hemorrhage.

The purpose of this study is to investigate the overall management outcome in patients with subarachnoid hemorrhage who were admitted in the ultra-early stage. A total of 601 patients with subarachnoid hemorrhage were classified into three groups, that is, those admitted within 6 hours (group 1: 371 cases, 62%), those admitted from 6 hours to day 3 (group 2: 145 cases, 24%) and those admitted from day 4 to 30 (group 3: 85 cases, 14%). The shorter the interval from hemorrhage to admission, the worse were the clinical and subarachnoid hemorrhage grades on admission. The operability rate of group 1 was lower than that of group 2 or 3-62%, 73%, and 71%, respectively. At 6 months the overall outcome of group 1 was significantly poorer than that of group 2 or 3; the mortality rate was 39%, 27%, and 19%, respectively. The poor outcome in group 1 was a result of a worse neurologic state compared with groups 2 and 3. By life-table analysis, the survival curve of group 1 was also significantly poorer than that of group 2 or 3; the 5-year survival probability was 50%, 64%, and 67%, respectively. However, when analyzing the survival curves in patients with admission grades I-III or in those who were operated on, differences among the three groups were insignificant. Regarding age, the long-term survival probability as well as the short-term outcome were definitely inferior in patients aged > or = 70 years, especially in group 1. It is concluded that while the management outcome in patients admitted in the ultra-early stage after subarachnoid hemorrhage was poorer than in those admitted at later stages, if the subjects were restricted to those with good risk or those who underwent surgery, the results were not necessarily poor.