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Subarachnoid haemorrhage in patients ⩾75 years: clinical course, treatment and outcome
  1. D J Nieuwkamp1,
  2. G J E Rinkel1,
  3. R Silva2,
  4. P Greebe1,
  5. D A Schokking2,
  6. J M Ferro2
  1. 1Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands
  2. 2The Hospital Santa Maria, Universidade de Lisboa, Lisbon, Portugal
  1. 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

Abstract

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.

  • GOS, Glasgow Outcome Scale
  • SAH, subarachnoid haemorrhage
  • WFNS, World Federation of Neurological Surgeons

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Footnotes

  • Published Online First 25 April 2006

  • Funding: This study was in part funded by an established clinical investigator grant from the Netherlands Heart Foundation to GJER (Grant D98.014), a grant from Fundação para a Ciência e Tecnologia (Grant PRAXIS 2/2.1/SAU/1414/95) to JMF and a grant from the Netherlands Organisation for Scientific Research/ZonMw (Grant 920-03-299) to DJN.

  • Competing interests: None.

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