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Aneurysmal subarachnoid haemorrhage (aSAH): Five consecutive years' experience of Fars province, Iran.

ABSTRACT: Subarachnoid haemorrhage (SAH), caused by the rupture of intracranial aneurysms, is a devastating event with high rates of morbidity and mortality. Aneurysmal subarachnoid haemorrhage (aSAH) plays a critical role in the potential loss of life as its sufferers are usually of a young age. We aimed to investigate the incidence of aSAH along with the patients' characteristics over five consecutive years in Fars, a large province located in Southern Iran.In this prospective study, anonymous data of all patients diagnosed with aSAH in Fars province were collected after patient admission and surgery. Data from the last national census in 2011 were used to calculate the incidence. The data were analysed using SPSS software version 18 using independent sample t test, chi square test and ANOVA. The significance level was set at 0.05.The number of aSAH cases identified in Fars, Iran, each year varied between 78 (2011) and 98 (2015) for a total of 421 aSAH cases within the 5-year study period. The annual aSAH incidence estimates showed no differences and were 1.65 [95% confidence interval (CI): 1.58-1.72], 1.70 (95%CI: 1.68-1.72), 1.71 (95%CI: 1.63-1.78), 1.82 (95%CI: 1.74-1.9), and 2.05 (95%CI: 1.97-2.13) per 100,000 persons, respectively, for the five consecutive years from 21 March 2011 to 20 March 2016. Hypertension was the most common risk factor, and was found in 198 (48%) aSAH patients. Ninety-four (22.5%) patients had moderate hydrocephalus on admission. Middle cerebral artery and anterior communicating artery were the most common sites of aneurysms. On admission, 351 (83%) patients had a Glasgow Coma Scale score >7, 197 (47%) presented with Hunt and Hess score of 1, and 365 (87%) had a Fisher score of ?3. Multiple aneurysms were found in 59 (14%) of the 421 cases and the most common risk factors in multiple aneurysms were hypertension in 30 (51%) and smoking in 26 (44%) cases. Survival data were available only on patients diagnosed in year 2015, and the six-month survival rate was 89.8%.This study revealed that although the incidence of aSAH remained stable, the survival of aSAH patients who reached the hospital alive and were operated on, improved in Shiraz (the six-month survival rate was 89.8% in year 2015). The incidence and survival study on aSAH in other geographic areas of Iran as a multi-centre study is recommended. There is a need to inform primary healthcare workers regarding the possibility of aSAH in a patient with signs of the sentinel headache.

SUBMITTER: Rahmanian A

PROVIDER: S-EPMC5708774 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Aneurysmal subarachnoid haemorrhage (aSAH): Five consecutive years' experience of Fars province, Iran.

Rahmanian Abdolkarim A Jamali Mohammad M Bagheri Lankarani Kamran K Ghahramani Sulmaz S

PloS one 20171130 11

<h4>Objective</h4>Subarachnoid haemorrhage (SAH), caused by the rupture of intracranial aneurysms, is a devastating event with high rates of morbidity and mortality. Aneurysmal subarachnoid haemorrhage (aSAH) plays a critical role in the potential loss of life as its sufferers are usually of a young age. We aimed to investigate the incidence of aSAH along with the patients' characteristics over five consecutive years in Fars, a large province located in Southern Iran.<h4>Methods</h4>In this pros ...[more]

PMID: 29190810

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Project description:The prognosis of patients with aneurysmal subarachnoid haemorrhage requiring decompressive craniectomy is usually poor. Proper selection and early performing of decompressive craniectomy might improve the patients' outcome. We aimed at developing a risk score for prediction of decompressive craniectomy after aneurysmal subarachnoid haemorrhage. All consecutive aneurysmal subarachnoid haemorrhage cases treated at the University Hospital of Essen between January 2003 and June 2016 (test cohort) and the University Medical Center Freiburg between January 2005 and December 2012 (validation cohort) were eligible for this study. Various parameters collected within 72 h after aneurysmal subarachnoid haemorrhage were evaluated through univariate and multivariate analyses to predict separately primary (PrimDC) and secondary decompressive craniectomy (SecDC). The final analysis included 1376 patients. The constructed risk score included the following parameters: intracerebral ('Parenchymal') haemorrhage (1 point), 'Rapid' vasospasm on angiography (1 point), Early cerebral infarction (1 point), aneurysm Sac > 5 mm (1 point), clipping (' S urgery', 1 point), age U nder 55 years (2 points), Hunt and Hess grade ≥ 4 ('Reduced consciousness', 1 point) and External ventricular drain (1 point). The PRESSURE score (0-9 points) showed high diagnostic accuracy for the prediction of PrimDC and SecDC in the test (area under the curve = 0.842/0.818) and validation cohorts (area under the curve = 0.903/0.823), respectively. 63.7% of the patients scoring ≥6 points required decompressive craniectomy (versus 12% for the PRESSURE < 6 points, P < 0.0001). In the subgroup of the patients with the PRESSURE ≥6 points and absence of dilated/fixed pupils, PrimDC within 24 h after aneurysmal subarachnoid haemorrhage was independently associated with lower risk of unfavourable outcome (modified Rankin Scale >3 at 6 months) than in individuals with later or no decompressive craniectomy (P < 0.0001). Our risk score was successfully validated as reliable predictor of decompressive craniectomy after aneurysmal subarachnoid haemorrhage. The PRESSURE score might present a background for a prospective randomized clinical trial addressing the utility of early prophylactic decompressive craniectomy in aneurysmal subarachnoid haemorrhage.

Project description:ObjectiveThe objective of the study was to assess the long-term self-reported health status and quality of life (QoL) of patients following an aneurysmal subarachnoid haemorrhage (ASAH) using a self-completed questionnaire booklet.DesignA two-cohort study.SettingA regional tertiary neurosurgical centre.Participants2 cohorts of patients with ASAH treated between 1998 and 2008 and followed up at approximately 1 year.InterventionsRoutine care.Primary and secondary outcomesA range of standardised scales included: AKC Short Sentences Test, the Barthel Index, the Self-Report Dysexecutive Questionnaire, the Everyday Memory Questionnaire, Stroke Symptom Checklist, Wimbledon Self-Report Scale, Modified Rankin Score (MRS) and a new Stroke-QoL. The data from summated scales were fit to the Rasch measurement model to validate the summed score.Results214 patients (48%) returned the questionnaires; the majority (76%) had a World Federation of Neurosurgeons grade of 1 or 2. The most frequent aneurysm type was that of the anterior communicating artery (28%) with approximately 90% of aneurysms of the anterior circulation. Of those previously in full or part-time employment, 48.9% were unemployed at follow-up. All summated scales satisfied the Rasch measurement model requirements, such that their summed scores were a sufficient statistic. Given this, one-third of patients were noted to have a significant mood disorder and 25% had significant dysexecutive function. Patients with an MRS of 3, 4 or 5 had significantly worse scores on most outcome measures, but a significant minority of those with a score of zero had failed to return to work and displayed significant mood disorder.ConclusionsA range of self-reported cognitive and physical deficits have been highlighted in a cohort of patients with ASAH. While the MRS has been shown to provide a reasonable indication of outcome, in routine clinical follow-up it requires supplementation by instruments assessing dysexecutive function, memory and mood.

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Aneurysmal subarachnoid haemorrhage (aSAH): Five consecutive years' experience of Fars province, Iran.

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Aneurysmal subarachnoid haemorrhage (aSAH): Five consecutive years' experience of Fars province, Iran.

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