Delayed diagnosis in subarachnoid haemorrhage

Med J Aust. 1991 Apr 15;154(8):509-11.

Abstract

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.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Adult
  • Female
  • Headache / etiology
  • Humans
  • Intracranial Aneurysm / complications*
  • Intracranial Aneurysm / surgery
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Recurrence
  • Retrospective Studies
  • Rupture, Spontaneous
  • Subarachnoid Hemorrhage / diagnosis*
  • Subarachnoid Hemorrhage / etiology
  • Subarachnoid Hemorrhage / surgery
  • Time Factors
  • Tomography, X-Ray Computed
  • Vomiting / etiology