Clinical Outcomes After High-Grade Aneurysmal Subarachnoid Hemorrhage (P5.124)

Background: The prediction of outcome after high-grade aneurysmal subarachnoid hemorrhage (aSAH) remains a complex and inexact venture. Clinical grades, such as the Hunt & Hess and the World Federation of Neurosurgical Societies (WFNS), were initially used to triage patients as to who would receive definitive treatment for their aneurysms. However, recent data has shown that no single clinical or radiographic score is valid to ascertain eligibility for treatment. Methods: Retrospective review data from all high-grade (WFNS 4 and 5) aSAH patients admitted to a 19-bed Neuro-ICU between January 2013 and June 2013. The primary outcome was in-hospital mortality. Secondary outcome measures included modified Rankin score (mRS) at the patient’s first visit to the neurovascular clinic, hospital and ICU length of stay. Results: Eighteen patients were identified in a six-month period (median age 61.6 years; 55% female). The percentage of patients with WFNS 4 and 5 were 16.7% and 83.3%, respectively. Twelve patients (66.6%) underwent emergency external ventriculostomy (EVD) and 3 (16.7%) required hematoma evacuation. 5 patients (41.7%) improved motor GCS after EVD. Four patients (22%) died before receiving definitive therapy for their aneurysm: 2 rapidly progressed to brain death, 2 did not improve within 72 hours in spite of aggressive treatment, including EVD insertion (treatment was shifted toward comfort measure based on patients and families wishes). Fourteen patients (77.7%) were taken to digital subtraction angiography (DSA), and 12 received definitive aneurysm treatment (75% endovascular coiling vs 25% surgical clipping). Of those fourteen patients, 10 (71.4%) left the hospital, with a mean length of ICU and hospital stay of, 12.7 and 16.6 days, respectively. Of those patients, who reached DSA, 5 (35.7%) had favorable outcome (defined as mRS ≤ 3). Conclusion: In patients with high-grade aSAH, there is still a 35.7% chance of an acceptable functional outcome. Preliminary data suggest that prognostication may be possible by the end of week 2. This early prediction model is being validated with further study. Disclosure: Dr. de Oliveira Manoel has nothing to disclose. Dr. Turkel-Parrella has nothing to disclose. Dr. Goffi has nothing to disclose. Dr. McCredie has nothing to disclose. Dr. Ben-Israel has nothing to disclose. Dr. Kouzmina has nothing to disclose. Dr. Spears has nothing to disclose. Dr. Marotta has received royalty, license fee, or contractual payments as co-inventor of Eclips. Dr. Abrahamson has nothing to disclose.