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Management and outcome of subarachnoid haemorrhage (SAH) in older

people: A centre series

Poster · September 2018

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8 authors, including:

Tarek Boumrah John Fahmy

St George's, University of London St George's, University of London
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Sarah Trippier Atticus H Hainsworth

St George's, University of London St George's, University of London
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 Management and outcome of subarachnoid haemorrhage (SAH) in older people: A centre series
Tarek 1
Boumrah , John Sarah 1
Fahmy ,
Atticus H 3
Trippier , 1
Hainsworth , Jeremy 4
Madigan ,
Erlick Pereira1,2, Pawanjit Minhas2 and Anan Shtaya1,2
1Molecular and Clinical Sciences Research Institute, St George’s, University of London, London. Corresponding author: Anan Shtaya, ashtaya@sgul.ac.uk
2Atkinson Morley Neurosurgery Centre, St George’s University Hospital NHS Foundation Trust, London.
3Stroke Unit, St George’s University Hospital NHS Foundation Trust, London.
4Neuroradiology Department, St George’s University Hospital NHS Foundation Trust, London.

INTRODUCTION
2.4% of people are over the age of 85 in the UK with that number rising to over 4% by 2036[1]. Older people have a higher frequency of
comorbidities [2] such as hypertension and small vessels disease [3]. A percentage of the elderly will develop SAH. However, factors that
predict the outcome following SAH in this age groups is not well studied. Therefore we set out to study the management and factors
associated with outcomes in SAH in people 80 years old and above.

METHODS
 This was a retrospective records review of patients with SAH at a busy tertiary neurosurgery unit.

 1079 patients admitted to the hospital over a 6 year period from 2012 – 2018. 32 of these patients were over 80 years of age (3%), 21 F
and 11 M, mean age 83.4 ± 0.5 (minimum 80 and maximum 92).

 We collected patients demographics, smoking, co-morbidities, WFNS Grade, GCS, motor scores, aneurysms size, location, IVH/ICH
(Intraventricular/Intracerebral haemorrhage), time of admission, treatment, complications, and outcomes using modified Rankin Scale
(mRS).

 We dichotomised the patients into a poor outcome group (POG) of mRS 4-6 and good outcome group (GOG) of mRS 0-3.

 We employed the Spearman’s rank-order test to analyse correlation between outcome mRS and all other variables.

RESULTS
 24 patients (75%) had poor outcome (with 42% mortality) vs 8
patients (25%) with good outcome (Fig 1).

 9 patients (38%) of POG were WFNS grades IV and V versus 1

mRS 4-5
patient (13%) in GOG.

 More POG patients had IVH in comparison to GOG (83% vs

38%, p=0.012). 20% of POG had ICH vs none in GOG (Table
mRS 6
1).

 GOG patients had higher GCS (rs=-0.37, p=0.04), lower WFNS

grade (rs=0.43, p=0.01) and did not need external ventricular Figure 1
drain (EVD) (rs=0.51, p=0.003) (Table 1).

 There was no significant correlation between outcomes and

patients’ age, sex, smoking, hypertension, size of aneurysm
(4.9±1.0 mm in GOG vs 5.4±1.1 mm in POG), percentage of
those receiving coiling or clipping, motor score, procedures
complications and general medical complications.
Table 1: Factors that predict good outcome

DISCUSSION
Older people with WFNS grades IV and V do badly in agreement with outcome in younger population. However, those who had
hydrocephalus, IVH/ICH and needed EVD insertion had poor outcome. 75% of patients had poor outcome with 42% mortality. We analysed
the patients demographics, risk factors, size of aneurysms, treatment, complications while an inpatient with no significant correlation with
outcome. However, our cohort is small (32 patients) to draw further conclusions.

CONCLUSION
In older people, 80 years old and above, WFNS grades IV and V, ICH/IV requiring CSF diversion are independent predictors of poor
outcome. These factors should be considered when managing these patients.

REFERENCES ACKNOWLEDGEMENTS
1. Hayter, C. (2018). Overview of the UK population - Office for National Statistics. [online] Ons.gov.uk. Available at:
https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukp NIHR Lectureship for Mr. Shtaya
opulation/july2017
2. Kassell, N., Torner, J., Haley, E., Jane, J., Adams, H. and Kongable, G. (1990). The International Cooperative Study on the Timing of Molecular and Clinical Sciences Institute at St George’s,
Aneurysm Surgery. Journal of Neurosurgery, 73(1), pp.18-36. University of London
3. Taylor, C., Yuan, Z., Selman, W., Ratcheson, R. and Rimm, A. (1995). Cerebral arterial aneurysm formation and rupture in 20,767
Katharine Harris and Carole Bramwell (Clinical Coding at St
elderly patients: hypertension and other risk factors. Journal of Neurosurgery, 83(5), pp.812-819.
George’s University Hospital)
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