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Age, Aneurysm Size, and High Fischer Score Bode Poorly for Subarachnoid Haemorrhage: Presented at ANA

By Paula Moyer

SAN FRANCISCO, CA -- November 3, 2003 -- Patients who have survived a subarachnoid haemorrhage are at risk of a poor functional outcome after discharge, despite a good initial Hunt and Hess grade, if they are more than 75 years old, had a large aneurysm, and had a high Fischer score, according to findings presented here October 20^th at the 128^th Annual Meeting of the American Neurological Association.

"This is a first step toward identifying predictors of poor outcomes in these patients," said principal investigator Augusto Parra, MD, MPH, an assistant professor in the stroke and critical care division of the department of neurology at Columbia University College of Physicians and Surgeons in New York City. "In future research, we will try to identify confounding variables."

Conventionally, when such patients have a good Hunt and Hess grade, defined as no more than 2, they are expected to have a good functional outcome after discharge. However, Dr. Parra and his co-investigators had noted that some of such patients still have a poor outcome; they initiated the study to assess predictors of poor functional outcomes.

They obtained the records of 683 consecutive patients who had had subarachnoid haemorrhage for whom they had complete discharge disposition information. In the total population, 12.4% had a poor outcome despite a good initial Hunt and Hess grade.

Among the total group, the investigators identified 110 patients who had a good Hunt and Hess grade on day 14 and who were not living in a nursing home or other supervised environment when they were admitted to the hospital. The investigators then compared those who had a good post-discharge functional outcome with those who had a poor outcome. The investigators then conducted a logistic regression to evaluate the impact of acute factors on patients' discharge status.

Among the 110 patients, they identified 30 who had poor post-discharge outcomes. Such patients were more likely to be age 75 or older compared to those who had good outcomes (p=0.000). Poor outcomes were also highly linked to elevated Fischer scores (p=0.004), larger ruptured aneurysms (p=0.006), and worse APACHE II scores (p=0.000). "Age, cardiovascular risk, vascular morbidity, large haemorrhage size, and neurophysical dysfunction were key predictors of poor outcome," Dr. Parra said.

In addition, such patients were also more likely to have arrhythmias (p=0.023), elevated cholesterol (p=0.014), a family history of brain aneurysms (p=0.012), coronary artery disease (p=0.02), peripheral vascular disease (p=0.037), and diabetes (p=0.027).

The study was funded by a Grant-in-Aid from the American Heart Association.


[Study title: Predictors of Discharge Functional Outcome in Good Grade Hunt & Hess Subarachnoid Hemorrhage Patients. Abstract 19]

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