Delayed diagnosis in subarachnoid haemorrhage.

OBJECTIVE: To determine the outcome in patients with subarachnoid haemorrhage from a ruptured aneurysm, particularly in those in whom the diagnosis was delayed. DESIGN: A two-year retrospective study of medical records of patients admitted to Westmead Hospital between July 1988 and June 1989. SETTING: A tertiary level teaching hospital. PATIENTS: Ninety-four patients treated for subarachnoid haemorrhage. In 15 cases the diagnosis was delayed. MAIN OUTCOME MEASURES: Death, disability, or functional recovery. RESULTS: Overall, 40 (42.5%) patients died, 14 (15%) were disabled, and 40 made a functional recovery. Of the 62 patients who were treated surgically 38 (61%) made a functional recovery compared with two of the 32 (6%) who were not. Of the 15 in whom the diagnosis was delayed seven (47%) made a functional recovery. Confirmation of the diagnosis was delayed in four of the latter group because a cranial computed tomography scan showed no abnormalities. CONCLUSIONS: Earlier diagnosis, allowing early definitive surgical treatment, may improve the outcome in aneurysmal subarachnoid haemorrhage. The results of a computed tomography scan are diagnostic only if they are positive--a negative result must be interpreted in conjunction with the clinical picture.