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Factors implicated in deaths from subarachnoid haemorrhage: are they avoidable?
P J Hutchinson1, H M Seeley, P J Kirkpatrick
1Academic Department of Neurosurgery, University of Cambridge, UK.
British Journal of Neurosurgery
|October 3, 2000
Summary
Subarachnoid hemorrhage deaths are often preventable. This audit found rebleeding and poor resuscitation were key factors, highlighting the need for faster clinical intervention in patients with subarachnoid hemorrhage.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH) is a critical condition with high mortality.
- Major causes of death include initial bleed effects, aneurysmal rebleeding, and delayed cerebral ischemia.
- Some SAH mortality factors are potentially preventable.
Purpose of the Study:
- To quantify potentially avoidable factors contributing to SAH mortality through a regional audit.
- To analyze medical records and CT scans of deceased SAH patients.
- To identify specific preventable causes of death in SAH patients.
Main Methods:
- Regional audit of 200 patients who died from SAH over 5 years in the East Anglian Region.
- Analysis of medical records and CT scans.
- Identification of factors like rebleeding, hydrocephalus, and resuscitation quality.
Main Results:
- 33 patients (WFNS Grade V with fixed pupils) were unsalvageable.
- Rebleeding caused 73% of deaths in good-grade patients (WFNS I-III), often due to treatment delays.
- Poor resuscitation (61%) and hydrocephalus (25%) were noted in poor-grade patients (WFNS IV-V).
Conclusions:
- Rebleeding is a primary cause of death in good-grade SAH patients.
- Correctable factors like hydrocephalus and resuscitation issues contribute to poor outcomes in SAH.
- Rapid and active clinical intervention is crucial for improving SAH patient survival.