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Subarachnoid haemorrhage in patients 75 years: clinical course, treatment and outcome

D J Nieuwkamp¹, G J E Rinkel¹, R Silva², P Greebe¹, D A Schokking², J M Ferro²

¹ Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands
² The Hospital Santa Maria, Universidade de Lisboa, Lisbon, Portugal

Correspondence to:
D J Nieuwkamp
Department of Neurology, University Medical Centre Utrecht, C03.236, PO Box 85500, 3584 CX Utrecht, The Netherlands; d.nieuwkamp{at}umcutrecht.nl

Background: The number of elderly patients being admitted with aneurysmal subarachnoid haemorrhage (SAH) has been increasing. Treatment of the aneurysm may be offset by the higher rate of surgical or endovascular complications.

Aim: To study the clinical condition at onset, complications during clinical course, treatment and outcome in a consecutive series of elderly patients.

Methods: Patients who were 75 years at the onset of SAH were selected from the databases of two hospitals. Data on clinical condition at onset (poor condition defined as World Federation of Neurological Surgeons (WFNS) Scale IV and V), clinical course, treatment and outcome were extracted. Univariate and multivariate regression analyses were carried out to identify predictors for in-hospital death and poor outcome, defined as death or dependency.

Results: The data of 170 patients were retrieved, of whom 25 (15%) patients were independent at discharge; none of these patients had been admitted in a poor condition. Poor clinical condition on admission (odds ratio (OR) 7.9; 95% confidence interval (CI) 3.7 to 17) and recurrent haemorrhage (OR 7.5; 95% CI 2.5 to 23) were the strongest predictors for in-hospital death. Recurrent haemorrhage was the strongest predictor for poor outcome in the subset of patients who were admitted in good clinical condition. In all, 10 of 47 (21%) patients were independent at discharge after neurosurgical clipping (n = 34) or endovascular coiling (n = 13).

Conclusion: Elderly patients with SAH have a poor prognosis. The effect of the initial haemorrhage is the most common reason for poor outcome. For patients who are admitted in good clinical condition, the most important complication leading to poor outcome is recurrent haemorrhage. Treatment of the aneurysm in patients 75 years is feasible, may improve the outcome and should be strongly considered in patients who are admitted in a good condition.

Abbreviations: GOS, Glasgow Outcome Scale; SAH, subarachnoid haemorrhage; WFNS, World Federation of Neurological Surgeons

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