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Research paper
Early neurological deterioration after subarachnoid haemorrhage: risk factors and impact on outcome
  1. Raimund Helbok1,2,
  2. Pedro Kurtz1,
  3. Matthew Vibbert1,
  4. Michael J Schmidt1,
  5. Luis Fernandez1,
  6. Hector Lantigua1,
  7. Noeleen D Ostapkovich1,
  8. Sander E Connolly1,3,
  9. Kiwon Lee1,
  10. Jan Claassen1,
  11. Stephan A Mayer1,3,
  12. Neeraj Badjatia1,3
  1. 1Department of Neurology, Division of Neurocritical Care, Columbia University College of Physicians and Surgeons, New York, New York, USA
  2. 2Clinical Department of Neurology, Neurological Intensive Care Unit, Medical University Innsbruck, Innsbruck, Austria
  3. 3Department of Neurosurgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
  1. Correspondence to Professor N Badjatia, Division of Critical Care Neurology, Department of Neurology, Columbia University, Milstein Hospital 8 Center, 177 Fort Washington Ave, New York, NY 10032 USA; NBadjatia{at};Raimund.Helbok{at}


Background Early neurological deterioration occurs frequently after subarachnoid haemorrhage (SAH). The impact on hospital course and outcome remains poorly defined.

Methods We identified risk factors for worsening on the Hunt–Hess grading scale within the first 24 h after admission in 609 consecutively admitted aneurysmal SAH patients. Admission risk factors and the impact of early worsening on outcome was evaluated using multivariable analysis adjusting for age, gender, admission clinical grade, admission year and procedure type. Outcome was evaluated at 12 months using the modified Rankin Scale (mRS).

Results 211 patients worsened within the first 24 h of admission (35%). In a multivariate adjusted model, early worsening was associated with older age (OR 1.02, 95% CI 1.001 to 1.03; p=0.04), the presence of intracerebral haematoma on initial CT scan (OR 2.0, 95% CI 1.2 to 3.5; p=0.01) and higher SAH and intraventricular haemorrhage sum scores (OR 1.05, 95% CI 1.03 to 1.08 and 1.1, 95% CI 1.01 to 1.2; p<0.001 and 0.03, respectively). Early worsening was associated with more hospital complications and prolonged length of hospital stay and was an independent predictor of death (OR 12.1, 95% CI 5.7 to 26.1; p<0.001) and death or moderate to severe disability (mRS 4–6, OR 8.4, 95% CI 4.9 to 14.5; p=0.01) at 1 year.

Conclusions Early worsening after SAH occurs in 35% of patients, is predicted by clot burden and is associated with mortality and poor functional outcome at 1 year.

  • Subarachnoid Haemorrhage
  • Intensive Care

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