Factors implicated in deaths from subarachnoid haemorrhage: are they avoidable?

Abstract

A bstract The major causesof death following subarachnoid haemorrhage are the effectsof the initial bleed, aneurysmal rebleeding and delayed cerebral ischaemia. Although in many cases the causes are unavoidable, in others they are potentially preventable. By conducting a Regional Audit of patients who have died from subarachnoid haemorrhage, we have attempted to quantify these concerns. The medical records and CT scans of 200 patients who died from subarachnoid haemorrhage in hospitals in the East Anglian Region over a 5-year period were analysed, with particular regard to the identification of potentially avoidable factors, including radiologically confirmed rebleeding, marked hydrocephalus, and poor fluid and electrolyte resuscitation. Thirty-three patientspresented with World Federation of Neurosurgical Societies (WFNS) Grade V with fixed pupils. These patients were deemed unsalvageable. Of the remainder, 106 were good grade (WFNS I-III) at initial presentation, 77 (73%) of whom died as a result of rebleeding (mean 10.4 days post-bleed) indicating delaysin transfer and definitive treatment. Of the 61 poor grade patients(W FNS IV and V with reactive pupils) marked hydrocephalus occurred in 15 (25%) and poor resuscitation in 37 (61%). These were considered contributing factorstotheir poor clinical condition. Rebleeding wasthe main cause of death in the good grade patients, and correctable factors were identified which are known to contribute to a poor clinical condition in poor grade patients. The need for more rapid and active clinical intervention is indicated.