Subarachnoid Haemorrhage: Prognostication
OVERVIEW
- some factors are modifiable
- mortality rates currently ~35%
- 15% die prior to reaching hospital
- 8-20% long-term dependence
Oli Flower discusses prognostication in aneurysmal SAH in this PK SMACC talk:
MOST IMPORTANT PROGNOSTIC FACTORS
- age
- LOC and neurological grade on initial presentation
- amount of blood on initial head CT
GRADING SYSTEMS
- see CCC entry on SAH Grading Systems
POOR PROGNOSTIC FACTORS
- worsens with increasing grade (I – 70% survival, V – 10% survival)
Patient factors
- age
- severe medical comorbidity
- hypertension
- past MI
- liver disease
- past SAH
- smoker
Aneurysm factors
- large aneurysm size
- ICH or IVH
- global cerebral oedema
- posterior circulation aneurysm (ACA have better prognosis)
- more complex aneurysm configuration
- blood > 1mm thick on CT
Modifiable risk factors for poor prognosis
- re-bleeding
- fever
- seizures and anticonvulsants (stop phenytoin at day 3 if no seizures)
- vasospasm
- hyperglycaemia
- anemia
- pneumonia
- sepsis
- treat at high volume centers with neurosurgical and IR services
References and Links
LITFL
- CCC — Subarachnoid Haemorrhage: Overview
- CCC — Subarachnoid Haemorrhage: ICU Management
- CCC — Monitoring in Subarachnoid Haemorrhage
- CCC — Subarachnoid Haemorrhage Grading Systems
- CCC — Vasospasm in Subarachnoid Haemorrhage
- CCC — Subarachnoid Haemorrhage: Initial Management
- CCC — Subarachnoid Haemorrhage: Prognostication
- CCC — Subarachnoid Haemorrhage: Complications
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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