Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management

• Published in: Stroke (1970) 2001-05, Vol.32 (5), p.1176-1180
• Main Authors: OHKUMA, Hiroki, TSURUTANI, Hisanobu, SUZUKI, Shigeharu
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood Pressure; Comorbidity; Disease Progression; Emergency Medical Services - statistics & numerical data; Hematoma - classification; Hematoma - diagnosis; Hematoma - epidemiology; Humans; Incidence; Japan - epidemiology; Medical sciences; Neurology; Neurosurgical Procedures; Prognosis; Recurrence; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - epidemiology; Subarachnoid Hemorrhage - therapy; Tomography, X-Ray Computed; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.str.32.5.1176

Rebleeding is a major cause of death and disability in aneurysmal subarachnoid hemorrhage (SAH); however, there has been no report focusing on rebleeding before hospitalization in neurosurgical or neurological institutions. The aim of this study was to clarify the incidence of prehospitalization rebleeding, its impact on the clinical course and prognosis in patients with aneurysmal SAH, and the possible factors inducing it. In 273 patients who were admitted to our institution within 24 hours after the initial SAH bleeding and whose clinical course before admission could be fully evaluated, the patients' clinical conditions and CT findings on admission, operability, prognosis, and possible factors inducing rebleeding were comparatively evaluated between the patients with and without an episode of prehospitalization rebleeding. Of the 273 patients, 37 (13.6%) patients suffered from 39 episodes of rebleeding in the ambulance or at the referring hospital before admission to our hospital. The peak time of rebleeding was within 2 hours (77%), in which the incidence was statistically significant compared with that occurring 2 to 8 hours after the initial SAH bleeding (P160 mm Hg was a possible risk factor of rebleeding (odds ratio 3.1, 95% CI 1.5 to 6.8). Rebleeding during transfer and at the referring hospital is not rare. To improve overall outcome of aneurysmal SAH, the results obtained in this study should be made available to general practitioners and the doctors devoted to emergency medicine.