Spontaneous Subarachnoid Haemorrhage as a Cause of Out-of-Hospital Death

• Published in: Journal of stroke and cerebrovascular diseases 2020-11, Vol.29 (11), p.105239-105239, Article 105239
• Main Authors: Sonne, Asger, Bækgaard, Emilie Stokholm, Banner, Jytte, Rasmussen, Lars Simon
• Format: Article
• Language: English
• Subjects: Autopsy; Cause of Death; Databases, Factual; Denmark - epidemiology; Emergency Medical Service; Female; Humans; Incidence; Male; Middle Aged; out-of-hospital death; Patient Acceptance of Health Care; Retrospective Studies; Subarachnoid haemorrhage; Subarachnoid Hemorrhage - mortality; sudden death; Time Factors
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2020.105239

•Out-of-hospital death occurs in 0.34 per 100.000 person-years.•The incidence rate of out-of-hospital death was stable across the years 2009–2018.•Several patients had sought medical attention within 72 h prior to their death.•The use of health care services indicates prodromal symptoms.•Patients presenting with prodromal symptoms are potentially saveable. There are no recent studies on the incidence rate of out-of-hospital death due to spontaneous subarachnoid haemorrhage (SAH). The primary aim of this study was to determine how often SAH was the cause of out-of-hospital death. The secondary aim was to determine if decedents had contacted any health care services within the last 72 h prior to the time of death. This was a retrospective cohort study. The reports of all autopsies carried out at the Department of Forensic Medicine in the Capital Region of Denmark in a ten-year period were read. Police records and Emergency Medical Services (EMS) telephone records were searched for health care contacts within the last 72 h prior to the time of death. Descriptive statistics were used, and to analyse the incidence rates for trend Poisson regression was used. In total, 6,903 decedents underwent autopsy. Out-of-hospital SAH was the cause of death in 58 decedents, resulting in an average incidence rate of 0.34 per 100.000 persons per year. No significant change in the incidence rate over time was found (p = 0.52). No EMS data were available for eleven decedents in the first part of the study period. Of the remaining 47 decedents, 2 (3.5%, 95% CI: 0.4-11.9) had called the EMS, and in regards to 27 of the 58 decedents, the police records contained information on health care system contacts. Five (8.6%, 95% CI: 2.9-18.9) patients had contacted a general practitioner and three (5.2%, 95% CI: 1.1-14.4) patients had been admitted to hospital but were discharged again within 72 h prior to their death. The incidence rate of out-of-hospital death from SAH was 0.34 per 100.000 persons per year and remained stable across the years 2009–2018. Several patients had sought medical attention shortly before their death, emphasizing the vital importance of recognizing the early symptoms of SAH.