Cost-effective outcome for treating poor-grade subarachnoid hemorrhage

Area of Science:

• Neurosurgery
• Critical Care Medicine
• Neurology

Background:

• Aneurysmal subarachnoid hemorrhage (aSAH) is a critical neurological condition.
• Poor-grade aSAH (World Federation of Neurological Surgeons grades 4-5) presents significant management challenges.
• Understanding outcomes and costs is crucial for resource allocation in neurosurgical centers.

Purpose of the Study:

• To prospectively evaluate clinical outcomes at 6 months for patients with poor-grade aSAH.
• To determine the number needed to treat (NNT) for achieving favorable outcomes.
• To conduct a cost analysis associated with treating poor-grade aSAH patients.

Main Methods:

• Patients with poor-grade aSAH were identified and managed in a neurocritical care unit.
• Intensive resuscitation and cerebrospinal fluid drainage were initial steps.
• Angiography and surgical aneurysm treatment were performed for patients with Glasgow Motor Score (GMS) ≥4, with specific exclusion criteria applied.

Main Results:

• 166 patients were classified as genuinely poor-grade aSAH.
• 88 patients proceeded to angiography and potential treatment.
• Operative mortality was 31.3%, with 34.4% of treated patients achieving a favorable outcome. Favorable outcomes were more common in women (21.3%) than men (6.9%).

Conclusions:

• Poor-grade aneurysmal subarachnoid hemorrhage carries a high mortality rate.
• A significant subset of these patients can achieve favorable outcomes with appropriate management.
• The NNT for a favorable outcome was 7, with substantial costs per favorable outcome, varying by sex.