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Clinical research
DOI: 10.1016/j.neucie.2020.08.005
Available online 12 September 2020
Clinical profile and evolution of patients with subarachnoid haemorrhage for 11 years
Perfil clínico y evolución de pacientes con hemorragia subaracnoidea durante 11 años
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Mónica Mourelo-Fariñaa,
Corresponding author
monica.mourelo@gmail.com

Corresponding author.
, Rita Galeirasa, Sonia Pértegab, Ana Vanesa Allera
a Critical Care Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), Universidade da Coruña (UDC), A Coruña, Spain
b Clinical Epidemiology and Biostatistics Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
Received 26 June 2019. Accepted 23 March 2020
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Tables (4)
Table 1. Sociodemographic characteristics, previous medical history and clinical manifestations on admission in patients with spontaneous subarachnoid haemorrhage during the study period.
Table 2. Distribution of patients with spontaneous subarachnoid haemorrhage according to the type of lesion during the study period, and therapeutic management of aneurysmal lesions.
Table 3. Sociodemographic characteristics, previous medical history, clinical manifestations and clinical status on admission according to type of lesion in patients with spontaneous subarachnoid haemorrhage.
Table 4. Complications and prognosis according to the type of lesion.
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Abstract
Introduction

Spontaneous subarachnoid haemorrhage is a rare cause of stroke, but it causes great socioeconomic impact and high morbidity and mortality.

The aim of this study is to describe the clinical profile and evolution of a series of patients with SAH admitted to a tertiary hospital, as well as the diagnostic and therapeutic management.

Material and methods

Retrospective study of 536 patients diagnosed with SAH admitted to the ICU of the Hospital Universitario de A Coruña between 2003 and 2013 (Age: 56.9 ± 14.1 years, female/male ratio: 1.5:1). Demographic characteristics, risk factors, aetiologies and clinical signs, prognostic scales, diagnostic tests and treatment were collected. A comparative analysis was made between the general series and subgroups of patients with aneurysmal (SAH-A) and idiopathic (SAH-I) subarachnoid haemorrhage.

Results

There were 49.0 ± 15.1 patients/year (2013 incidence: 4.3/100,000 inhabitants). 60.3% presented Glasgow Coma Scale (GCS) 14-15, with scarce symptomatology (Hunt-Hess I-II 61.9%, World Federation Neurosurgeons Scale I-II 60.4%). 50.7% presented Fisher IV.

SAH-A was diagnosed in 78.3% (n = 396); perimesencephalic subarachnoid haemorrhage (SAH-PM) in 3.2%; and SAH-I in 17.9%. During the study period there was an increase in the prevalence of aneurysms, causing an increased number of surgeries in recent years. Both SAH-A and SAH-I presented greater severity upon admission. Patients with SAH-A had higher percentage of complications and mortality, with lesser degree of independence at 6 and 12 months.

Conclusions

The incidence of SAH appears to have decreased in recent years, with SAH-I comprising 17.9% of the cases. Patients with SAH-I have better prognosis and lower risk of complications, highlighting the benignity of SAH-PM.

Keywords:
Spontaneous subarachnoid haemorrhage
Intracranial aneurysm
Perimesencephalic haemorrhage
Vasospasm
Clipping
Prognosis
Resumen
Introducción

La hemorragia subaracnoidea espontánea es una causa poco frecuente de ictus que ocasiona gran impacto socioeconómico y elevada morbimortalidad.

El objetivo de este estudio es describir el perfil clínico y evolución de una serie de pacientes con HSA ingresados en un hospital terciario, así como el manejo diagnóstico-terapéutico.

Material y métodos

Estudio retrospectivo de 536 pacientes diagnosticados de HSA ingresados en la Unidad de Cuidados Intensivos del Hospital Universitario de A Coruña de 2003–2013 (edad: 56,9 ± 14,1 años, ratio mujer/hombre:1,5:1). Se recogieron características demográficas, factores de riesgo, etiología y clínica, escalas pronósticas, pruebas diagnósticas y tratamiento. Se realizó un análisis comparativo entre la serie general y subgrupos de pacientes con HSA aneurismática (HSA-A) e idiopática (HSA-I).

Resultados

Se registraron 49,0 ± 15,1 pacientes/año (incidencia 2013:4,3/100.000 habitantes). 60,3% presentaban Glasgow Coma Scale 14-15, con escasa sintomatología (Hunt-Hess (H-H) I-II 61,9%; World Federation Neurosurgeons Scale (WFNS) I-II 60,4%). 50,7% presentaban Fisher IV. En 78,3%(n = 396) se diagnosticó HSA-A, 3,2% presentaban sangrado perimesencefálico (HSA-PM) y HSA-I 17,9%. Durante el periodo de estudio se registró aumento de la prevalencia de aneurismas, incrementándose en los últimos años la cirugía. Tanto la HSA-A como HSA-I presentaban mayor gravedad al ingreso. Los pacientes con HSA-A presentaron mayor porcentaje de complicaciones y mortalidad, con menor grado de independencia a 6 y 12 meses.

Conclusiones

La incidencia de HSA tiende a descender en los últimos años, representando la HSA-I el 17,9% de los casos. Los pacientes con HSA-I tienen mejor pronóstico y menor riesgo de complicaciones, destacando la benignidad de la HSA-PM.

Palabras clave:
Hemorragia subaracnoidea espontánea
Aneurisma intracraneal
Hemorragia perimesencefálica
Vasoespasmo
Pinzamiento
Pronóstico

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