医学
蛛网膜下腔出血
动脉瘤
队列
共病
蛛网膜下腔出血
队列研究
内科学
儿科
外科
作者
Frederick Ewbank,Samuel Hall,Ben Gaastra,Benjamin Franklin Fisher,Laura Coe,James Booker,Antony Kaldas,Ian Anderson,Giles Critchley,Mario Teo,Ahmed K. Toma,Rikin Trivedi,Christopher Uff,Raghu Vindlacheruvu,Louise Dulhanty,Mohsen Javadpour,Daniel Walsh,James Galea,Hiren C. Patel,Diederik Bulters
标识
DOI:10.1080/02688697.2023.2205939
摘要
An increasing proportion of aneurysmal subarachnoid haemorrhage (aSAH) occurs in older patients, in whom there is widespread variability in treatment rates due to a different balance of risks. Our aim was to compare outcomes of patients over 80 years old with good grade aSAH who underwent treatment of their aneurysm with those who did not.Adult patients with good grade aSAH admitted to tertiary regional neurosciences centres contributing to the UK and Ireland Subarachnoid Haemorrhage Database (UKISAH) and a cohort of consecutive patients admitted from three regional cohorts were included for analysis. Outcomes were functional outcome at discharge, three months and survival at discharge.In the UKISAH, patients whose aneurysm was treated were more likely to have a favourable outcome at discharge (OR 2.34, CI 1.12-4.91, p = .02), at three months (OR 2.29, CI 1.11-4.76, p = .04), and lower mortality (10% vs. 29%, OR 0.83, CI 0.72-0.94, p < .01). In the regional cohort, a similar pattern was seen, but after correction for frailty and comorbidity there was no difference in survival (HR 0.45, CI 0.12-1.68, p = .24) or favourable outcome at discharge (OR 0.83, CI 0.23-2.94, p = .77) and at three months (OR 1.03, CI 0.25-4.29, p = .99).Better early functional outcomes in those undergoing aneurysm treatment appear to be explained by differences in frailty and comorbidity. Therefore, treatment decisions in this patient group are finely balanced with no clear evidence overall of either benefit or harm in this cohort.
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